Gastrointestinal endoscopic evaluation and management in neonates: a 10-Year clinical experience

Gastrointestinal endoscopy is rarely performed in neonates due to concerns regarding safety and technical feasibility. This study aimed to evaluate its safety, feasibility, and diagnostic yield, and to explore its role as both a diagnostic and therapeutic tool in neonatal gastrointestinal diseases. This retrospective study included 42 neonates, both preterm and term, who underwent gastrointestinal endoscopy at Shanghai Children's Hospital between 2015 and 2025. Indications for endoscopy, endoscopic findings, therapeutic approaches and follow-up outcomes were analyzed. All neonates underwent successful gastroscopy, including 4 who also received colonoscopy. The cohort included both term and preterm infants. The most common indication was gastrointestinal bleeding, particularly hematemesis. In preterm neonates, the primary indications were feeding intolerance and the need for enteral nutritional support. Abnormal endoscopic findings were identified in over 85.7% of infants, including mucosal erosion, ulcer, hemorrhagic lesion, congenital or acquired mechanical obstruction and inflammation. Endoscopic interventions included topical hemostatic therapy, nasojejunal tube placement, and balloon dilation. No procedure-related complications such as perforation, respiratory deterioration were observed.

With ongoing advances in gastrointestinal endoscopy and increasing clinical experience, its use in neonates has expanded. In some cases, endoscopy serves as an adjunct to diagnostic evaluation and therapeutic management.

• Gastrointestinal endoscopy is rarely performed in neonates due to technical limitations and concerns regarding safety. • Most existing studies involve small case series, offering limited data on diagnostic yield and therapeutic potential.

• A 10-year clinical cohort demonstrates that endoscopy is safe and feasible in both term and preterm neonates using ultrathin instruments. • Endoscopy provides substantial diagnostic value for diverse neonatal gastrointestinal conditions and enables targeted therapeutic interventions, including topical hemostatic therapy, Nasojejunal tube placement, and balloon dilation.