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Interventional endoscopy for abdominal transplant patients
Tom K Lin1, Maisam Abu-El-Haija1, Juan P Gurria2
1Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC 2010, Cincinnati, OH 45229, United States; Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, United States.
Insights
Interventional endoscopy is crucial for pediatric solid organ transplant patients, aiding in pre- and post-transplant care. Advanced procedures like ERCP and EUS are vital for managing complications and complex conditions such as chronic pancreatitis.
Area of Science:
- Pediatric Gastroenterology
- Transplant Surgery
- Interventional Endoscopy
Background:
- Pediatric abdominal solid organ transplantation requires specialized care.
- Interventional endoscopic procedures are essential for managing transplant patients.
- Access to advanced pediatric endoscopy is often limited to tertiary care centers.
Purpose of the Study:
- To review the role of interventional endoscopy in pediatric solid organ transplantation.
- To discuss pre- and post-transplant endoscopic management strategies.
- To highlight endoscopic interventions for complications and related conditions like chronic pancreatitis.
Main Methods:
- Review of interventional endoscopic procedures in pediatric transplant care.
- Discussion of techniques including ERCP, EUS, and BAE.
- Exploration of therapeutic applications of standard endoscopy.
Main Results:
- Interventional endoscopy significantly impacts pediatric transplant patient management.
- Procedures like ERCP, EUS, and BAE are key for pre- and post-transplant care.
- Endoscopic interventions are critical for managing surgical complications and pancreatitis.
Conclusions:
- Interventional endoscopy is indispensable for pediatric solid organ transplant recipients.
- Specialized centers are vital for providing advanced endoscopic care.
- Endoscopic techniques are crucial for managing complex gastrointestinal issues in transplant patients.
Abstract:
Interventional endoscopy can play a significant role in the care and management of children pre-and post- abdominal solid organ transplantation. Such procedures primarily include endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasound (EUS), and balloon-assisted enteroscopy (BAE), though additional interventions are available using standard endoscopes (gastroscopes, colonoscopes) for therapeutics purposes such as endoscopic hemostasis. The availability of pediatric practitioners with the advanced training to effectively and safely perform these procedures are most often limited to large tertiary care pediatric centers. These centers possess the necessary resources and ancillary staff to provide the comprehensive multi-disciplinary care needed for these complex patients. In this review, we discuss the importance of interventional endoscopy in caring for transplant patients, during their clinical course preceding the potential need for solid organ transplantation and inclusion of a discussion related to endoscopic post-surgical complication management. Given the highly important role of interventional endoscopy in patients with recurrent and chronic pancreatitis, we also include a discussion related to this complex disease process leading up to those patients that may need pancreas surgery including total pancreatectomy with islet autotransplantation (TPIAT).
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