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.
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.
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.
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.
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 ...