Pediatric Endoscopy and High-risk Patients: A Clinical Report From the NASPGHAN Endoscopy Committee

Area of Science:

• Pediatric Gastroenterology
• Gastrointestinal Endoscopy
• Patient Safety

Background:

• Pediatric gastrointestinal endoscopy is a safe and effective diagnostic and management tool.
• Certain patient and procedural factors elevate the risk of adverse events (AEs) during and after endoscopy.
• AEs include sedation-related issues, bleeding, perforation, and infection.

Purpose of the Study:

• To guide clinicians in stratifying patient risks for pediatric endoscopy.
• To outline clinical practices for minimizing AEs during and after endoscopic procedures.
• To discuss infection risks and antibiotic prophylaxis in pediatric endoscopy.

Main Methods:

• Review of patient factors increasing AE risk (e.g., cardiopulmonary diseases, craniofacial abnormalities, coagulopathies, immune compromise).
• Identification of high-risk patient groups (e.g., congenital heart disease, IBD, cancer patients).
• Discussion of risk mitigation techniques (e.g., CO2 insufflation, biopsy techniques, loop reduction).

Main Results:

• Specific patient conditions (congenital heart disease, IBD, cancer) are associated with higher risks.
• Techniques like CO2 insufflation and careful endoscopic maneuvers can reduce bleeding and perforation risks.
• The report addresses infection risks and antibiotic use.

Conclusions:

• Clinicians must recognize and stratify risks in pediatric endoscopy patients.
• Implementing specific techniques can significantly minimize adverse events.
• This guidance aims to enhance safety in pediatric gastrointestinal endoscopy.