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Gastrointestinal endoscopy involves examining the inside of the gastrointestinal tract using a lighted flexible or rigid instrument called an endoscope. An endoscope is generally introduced into the body through the mouth or anus. As a medical procedure, endoscopy has been performed since the early nineteenth century, and originally involved the use of alcohol or turpentine lamps as light sources for rigid instruments.1 The birth of modern endoscopy can be dated to the 1960s with the development of flexible fiberoptic instruments. These allowed visualization of areas beyond the reach of rigid instruments and greatly improved patient comfort. The development of fiberoptic illumination further improved endoscopic safety by removing thermal and electrical complications from the procedure. Flexible fiberoptic endoscopes were further modified in the 1980s by replacing fiberoptic image bundles with a charge-coupled device (CCD) video camera, which provided greater image detail and display on a video screen. CCD chip size has become smaller over time, further allowing the size of endoscopes to become smaller.

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In the 1970s, the diameter of endoscopes became small enough to allow investigation of children.2 Prior to the use of endoscopy, gastrointestinal diseases were diagnosed mostly by fluoroscopic contrast studies. Over the past four decades, gastrointestinal endoscopy has been shown to be safe and effective in diagnosis and treatment of children. In the 1980s, endoscopes were designed specifically for use in children, thereby cementing the importance of endoscopy in the field of pediatric gastroenterology.

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Today, the diagnosis of gastrointestinal diseases in children can be made more accurately and quickly as a result of direct visualization of tissue and targeted tissue biopsies. In addition, therapeutic endoscopy has allowed for safe, minimally invasive treatments that were once only performed by open surgical techniques with longer recovery periods. As a result of endoscopy, the field of pediatric gastroenterology has grown tremendously. The contributions of endoscopy to pediatric gastroenterology will continue to grow as technology continues to progress.

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In this chapter, we review the fundamentals of pediatric endoscopy. In particular, we describe the endoscopy unit as a clinical resource for children with gastrointestinal disease, as well as necessary steps that must be followed by both clinicians and families in preparation for endoscopic procedures. We also provide descriptions of different diagnostic and therapeutic procedures, as well as indications for their performance, and discuss post-endoscopy care.

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Generally speaking, a pediatric endoscopy unit is comprised of a reception and waiting area, preprocedure preparation facilities, procedure rooms, and a recovery suite.3 The waiting area allows patients to check in and families to gather while their child is having a procedure. This area should be a fun and inviting place where young children will feel comfortable. Most units have an initial preparation area where the patient will undress and informed consent is obtained. The next area of the unit is the procedure area (see Figure 10–1). This is often composed of multiple rooms where multiple providers ...

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