Table Of Content

Practical Pediatric Gastrointestinal Endoscopy Practical Pediatric Gastrointestinal Endoscopy Third Edition Edited by George Gershman Professor of Pediatrics, David Geffen School of Medicine Chief, Division of Pediatrics Gastroenterology, Hepatology and Nutrition Harbor-UCLA Medical Center Torrance, California, USA Mike Thomson Professor of Paediatric Gastroenterology and Interventional Endoscopy Director of the International Academy for Paediatric Endoscopy Training Centre for Paediatric Gastroenterology, Nutrition and Haepatology Sheffield Children’s Hospital NHS Foundation Trust Sheffield, UK; Portland Hospital for Women and Children London, UK This edition first published 2021 © 2021 John Wiley & Sons Ltd Edition history Blackwell Publishing Ltd. (2e, 2011) All rights reserved. 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Identifiers: LCCN 2020022834 (print) | LCCN 2020022835 (ebook) | ISBN 9781119423454 (hardback) | ISBN 9781119423416 (adobe pdf) | ISBN 9781119423485 (epub) Subjects: MESH: Endoscopy, Gastrointestinal | Pediatrics–methods | Child | Infant Classification: LCC RJ446 (print) | LCC RJ446 (ebook) | NLM WI 190 | DDC 618.92/3307545–dc23 LC record available at https://lccn.loc.gov/2020022834 LC ebook record available at https://lccn.loc.gov/2020022835 Cover Design: Wiley Cover Image: © FatCamera/Getty Images Set in 9.5/12.5pt STIXTwoText by SPi Global, Pondicherry, India 10 9 8 7 6 5 4 3 2 1 v Contents Personal statements ix Contributors xvii About the Companion Website xxiii Part One Pediatric Endoscopy Setting 1 1 Introduction 3 George Gershman and Mike Thomson 2 History of pediatric gastrointestinal endoscopy 5 Samy Cadranel, Jean-François Mougenot, and Douglas S. Fishman 3 The endoscopy unit 11 Harpreet Pall 4 Pediatric procedural sedation and general anesthesia for gastrointestinal endoscopy 15 Tom Kallay, Rok Orel, and Jernej Brecelj 5 Pediatric endoscopy training and ongoing assessment 23 Catharine M. Walsh, Looi Ee, Mike Thomson, and Jenifer R. Lightdale 6 Recertification and revalidation as concepts in pediatric endoscopy 31 Priya Narula and Mike Thomson 7 The role of the Global Rating Scale in pediatric endoscopy 33 Priya Narula and Mike Thomson 8 Quality indicators as a critical part of pediatric endoscopy provision 37 Priya Narula and Mike Thomson 9 e-learning in pediatric endoscopy 41 Claudio Romano and Mike Thomson vi Contents Part Two Diagnostic Pediatric Endoscopy 43 10 Indications for gastrointestinal endoscopy in childhood 45 Dalia Belsha, Jerome Viala, George Gershman, and Mike Thomson 11 Diagnostic upper gastrointestinal endoscopy 53 George Gershman and Mike Thomson 12 Pediatric ileocolonoscopy 77 George Gershman and Mike Thomson 13 Handling of specimens and orientation of biopsies 113 Marta C. Cohen and Paul Arnold 14 Enteroscopy 117 Mike Thomson and Arun Urs 15 Wireless capsule endoscopy 129 Mike Thomson 16 Endoscopic ultrasonography 141 Simona Faraci, Luigi Dall’Oglio, Paola de Angelis, and Douglas S. Fishman 17 Chromoendoscopy 157 Mike Thomson and Paul Hurlstone 18 Confocal laser endomicroscopy in the diagnosis of pediatric gastrointestinal disorders 167 Mike Thomson and Krishnappa Venkatesh 19 High-risk pediatric endoscopy 175 Jenifer R. Lightdale, Mike Thomson, and Douglas S. Fishman Part Three Pediatric GI Pathologies and the Role of Endoscopy in Their Management 183 20 Esophagitis 185 Mário C. Vieira, Luciana B. Mendez Ribeiro, and Sabine Krüger Truppel 21 Eosinophilic esophagitis 195 Calies Menard-Katcher, Glenn T. Furuta, and Robert E. Kramer 22 Gastritis and gastropathy 201 Shishu Sharma and Mike Thomson Contents vii 23 Celiac disease 207 Alina Popp, Vasile Daniel Balaba, and Markku Mäki 24 Role of endoscopy in inflammatory bowel disease including scoring systems 213 Salvatore Oliva, Mike Thomson, David Wilson, and Dan Turner Part Four Therapeutic Pediatric Endoscopy 221 25 Endoscopic management of esophageal strictures 223 Michael Manfredi, Frederick Gottrand, Luigi Dall’Oglio, Mike Thomson, George Gershman, Antonio Quiros, and Thierry Lamireau 26 Endoscopic management of caustic ingestion 235 Erasmo Miele and Samy Cadranel 27 Pneumatic balloon dilation and peroral endoscopic myotomy for achalasia 241 Valerio Balassone, Mike Thomson, and George Gershman 28 Endoscopic approaches to the treatment of gastroesophageal reflux disease 249 Mike Thomson and Chris Fraser 29 Foreign body ingestion 261 Raoul Furlano, George Gershman, and Jenifer R. Lightdale 30 Non-variceal endoscopic hemostasis 269 George Gershman, Jorge H. Vargas, and Mike Thomson 31 Variceal endoscopic hemostasis 279 Patrick McKiernan, Lauren Johanson, and Mike Thomson 32 Endoscopic approach to obscure gastrointestinal bleeding lesions 287 Natalia Nedelkopoulou, Sara Isoldi, Dalia Belsha, and Mike Thomson 33 Percutaneous endoscopic gastrostomy 295 Natalie Bhesania, Mike Thomson, and Marsha Kay 34 Single-stage percutaneous endoscopic gastrostomy 305 Andreia Nita, Jorge Amil-Dias, Arun Urs, Mike Thomson, and Prithviraj Rao 35 Pediatric laparoscopic-assisted direct percutaneous jejunostomy 317 Mike Thomson, Jonathan Goring, Richard Lindley, and Sean Marven 36 Naso-jejunal and Gastro-jejunal tube placement 323 George Gershman viii Contents 37 Endoscopic retrograde cholangiopancreatography 325 Douglas S. Fishman, Paola de Angelis, Luigi Dall’Oglio, and Victor Fox 38 Endoscopic drainage of pancreatic pseudocysts 343 Mike Thomson 39 Duodenal web division by endoscopy 347 Mike Thomson, Shishu Sharma, Filippo Torroni, and Jonathan Goring 40 Polypectomy 351 George Gershman, Mike Thomson, and Gabor Veres 41 Endomucosal resection 361 Mike Thomson and Paul Hurlstone 42 Endoscopic management of polyposis syndromes 371 Warren Hyer, Mike Thomson, and Thomas Attard 43 Transnasal gastrointestinal endoscopy 377 Sara Koo, Kristina Leinwand, Simon Panter, and Joel A. Friedlander 44 Endoscopic bariatric approaches 387 Mike Thomson and Matjaz Homan 45 Over-the-scope clip and full-thickness resection device 393 Mike Thomson 46 Endoscopic treatment of gastrointestinal bezoars 397 Andreia Nita and Mike Thomson 47 Natural orifice transendoluminal surgery 401 Mike Thomson Index 403 ix Personal statements George Gershman endoscopes, single- and double-balloon enter- To the new generations of pediatric gastroenter- oscopes, endoscopic capsules, and many other ologists and endoscopy enthusiasts: a letter to innovations which have opened unlimited the future. diagnostic and therapeutic possibilities in the field of pediatric gastroenterology. Once upon a time, there was a young fellow in You, my young colleague, who have opened Moscow, Russia, who was a resident working in a new page of your life, step into a fascinating one of the oldest hospitals in Moscow, named journey of new discoveries in pediatric after Yevgeny Botkin, court physician to Tsar gastroenterology. Nicholas II (who was murdered along with the I express my deep gratitude to Dr Eduard entire Tsarust family by Bolsheviks in 1918). Rokhlin, who was my endoscopy mentor and The training was all about patient care. The dear friend; Professor Samy Cadranel and diagnostic tools were limited to a stethoscope, Jean-François Mougenot: two remarkable phy- basic laboratory support, and X-rays. The time sicians and endoscopists who opened the door felt almost frozen. for me to enter the world of European commu- One day, I heard a rumor that one of the nity of pediatric gastroenterology; Professor attending physician named Eduard Rokhlin Jon A. Vanderhoof, who gave me the opportu- was performing unique procedures, and out of nity to share my endoscopy skills and scientific curiosity I asked for permission to watch. data with my American colleagues at the To my surprise, I was allowed not only to Annual Meeting of North American Society of observe the study but look inside the endo- Pediatric Gastroenterology and Hepatology in scope. I still remember that moment of excite- 1989; and Professor Marvin E. Ament, one of ment and disbelieve that I was looking inside the pioneers of pediatric GI endoscopy, who the stomach of a live person in real time. It invited me to work with him at UCLA in Los was the moment which changed my life. I was Angeles. Finally, this book would not be pos- fortunate to witness the fast progression of sible without love abd support of Irina, my flexible endoscopy from a primitive stage of amazing wife and healer and my daughter large-caliber fiberscopes with an eyepiece Zhenya, a talanted artist, educated and art resembling that of old microscopes to modern historian and my grandauphter Nikka, a truly high-definition, slim and ultra-slim video gifted musician and composer. x Personal statements Mike Thomson main left and right bronchi without going Why Pediatric Endoscopy? further? Or even just the left lung and not the right?! Please forgive this indulgence, but as you may My first inspirational moment came when I divine from this, I am clearly a little too took up the position of GI/Hepatology Fellow focussed, and some may say ‘sad and obsessed’, in the Royal Brisbane Children’s Hospital in with this area of medicine! Australia in 1989 - a perfect equation of work Like most things in life, and particularly in hard/play hard. My mentor Prof Ross Shepherd the serendipitous, chaotic and mal-designed was, and is, one of the most astute clinicians I world of medical careers, I ‘fell’ in to endoscopy have had the good fortune to learn from - and in children. Which does sound a little ‘messy’! luckily he was a great teacher of endoscopy as I am very grateful to George my co-Editor well. Prof Geoff Cleghorn and Dr Mark Patrick and massive contributor for the opportunity to deserve mention here as well and imparted join him in this venture - we did it together for knowledge and skill tips that I have not forgot- the Second Edition 10 years ago, and this ver- ten. Australia at this point were streets ahead of sion has massively surpassed that one. Marvin Europe in this area and in the 5 years I was Ament should not be forgotten as an integral there I had an accelerated endoscopy training, part of the first and second Editions - a real which, like many things in medicine, was down progenitor of paediatric endoscopy. We hope to good luck rather than good management. that this Third Edition has kept pace with this Also undertook my MD Doctorate on CF here. fast-changing field. Quick story - on our research staff we had a I was first exposed to endoscopy in children vet called Ristan Greer and I had a patient who in 1986 in a large teaching hospital in the had recurrent H pylori type bug called then North of England where it was ‘hold them Gastrospirillum hominis (now Helicobacter down, minimally sedate, and get on with it.’ heilmanii) only usually previously seen in cats Things have changed a bit since then! and dogs – we agreed to scope the cats and However, to be fair, at that point, I did not ‘get dogs at their farm with Ristan anesthetising the bug’ for pediatric endoscopy. It was really them and using an old scope that was to be still in its infancy, having been championed in thrown out we identified the micro-organism the late 1970s and early 1980s by such giants of in the cats, gave eradication to the girl and the the field as Sami Cadranel (so sadly, recently cats simultaneously, and she was ‘cured’. Cue a left us), Marvin Ament and Jean-Francois- paper in The Lancet. Mougenot. Sami, Jean-Francois and I were Watersheds occur in life, and I chose, for (much) later get to know each other and family reasons, to return to the UK in 1994. become friends. They and many others set the Birmingham and Dame Professor Deirdre scene for the undertaking of children’s Kelly CBE and her world-leading liver unit endoscopy by children’s specialists in GI – a awaited. Gulp. Without doubt one of the most cause I have always believed in and tried to inspirational women and doctors in the UK, to implement. Who wants an adult surgeon this day. When I first arrived, I met Sue the doing a quick sigmoidoscopy on your child amazing PA to Deirdre, and after she had with suspected Crohn’s and taking no biop- shown me my office – in a Portacabin! – I asked sies? Never mind not getting to the ileum! her ‘Are you doing that accent for a joke?’ It Hobby horse time – I always call the lower GI took a while for me to get back in to her good procedure an ileo-colonoscopy not simply a books! It was easy transferring skills but not so colonoscopy. Why, for instance, would you be easy adapting back to a West Midlands climate. happy with having a bronchoscopy where the I loved my time there but the only things that bronchoscopist only examined the trachea and the two cities have in common is the letter ‘B’. Personal statements xi No beach or surf in Brummie. Made some respiratory rescue. ‘Let the anaesthetists do great life-long friends there though. I clearly what they want to keep the child still, unknow- remember getting a phone call, possibly ing and amnesic and don’t get involved’ has ‘tongue in cheek’, from the head histopatholo- always been my mantra. Cost and availability gist in Birmingham Children’s Hospital two of anaesthetists is the only reason why it still weeks after I had started. I had performed a happens in the bad old way. scope on a post-transplant girl and sent the So I had a vision - please forgive me for biopsies off. He said I had mislabelled the sam- sounding like a prima donna! The John Walker- ples because I had put ‘terminal ileum’ on one, Smith Unit had been running a brilliant Paeds and they hadn’t seen that label for years, so Gastro Course in December in London for at was I sure! And so to another mentor, the least 12 years. As the young guy and the endos- extraordinary Deirdre Kelly, from whom I copy enthusiast I thought ‘why not add on a learnt many things - but not much endoscopy. live endoscopy day?’ John was very receptive But another good friend which the journey of and the first one was a real experiment but it medicine has allowed me to make. She was worked. I still owe Simon an apology for train- instrumental in my application to then become ing the room camera on him as he was scoping a Consultant with the incomparable Prof John and videoing his ‘gurnying’ (facial movements Walker-Smith, one of the fathers of our disci- as if in pain), during a live ileo-colonoscopy, to pline, at the Royal Free Hospital in London. 150 people in the main auditorium! Fortunately, Got lost, nearly missed the interview, swore I he has a great and forgiving sense of humour. would never work and live in London - got the It was probably the first ever successful live job and moved to London. paediatric endoscopy meeting. The close inter- The next ten years were eye-opening. The action with scientists such as Alan Phillips also ‘dream-team’ of JAWS (which acronym I came out in this Course with biopsy orientation know he dislikes), Simon Murch, Alan Phillips, and handling adding another dimension. The me and latterly Rob Heuschkel were as close Meeting seemed, apparently, to work smoothly - to a medical family as is possible. We should but a bit like a swan gliding serenely over the remember here our friend Dave Casson who lake’s surface, meanwhile its legs swimming sadly passed away from gastric cancer. frenetically beneath, we were frantically trying Importantly I was privileged to learn at John’s to get all the pieces of the jigsaw to fit together feet but almost, if not more, significant for me, and at the appropriate time. It was amazing and I was able to hone my apprentice-type ileo- a real privilege to be able to invite the great and colonoscopy skills with the greatest of them good from the world of paediatric endoscopy all, Prof Christopher Williams. A unique char- over to London to teach over the next 10 years - acter is a fair way to describe him, but he is Victor Fox, Luigi Dall’Oglio, Jean-Francois acknowledged as having been the best of the Mougenot, Jean-Pierre Olives, Sami Cadranel, best when it came to ileo-colonoscopy training. Yvan Vandenplas, Ernie Seidman, Harland Simon Murch, John Fell and I learnt a great Winter, Athos Bousvaros, Raoul Furlano and of deal. We were in the mid-nineties, however, course Eric Hassall. Other giants of the field I still iv drug users! Eric Hassall, the famous was to meet later. North American paediatric gastroenterologist Over the next ten years we worked closely and a good and wise friend, once wrote a paper with the adult GI Unit and Prof Owen Epstein ‘Why pediatric endoscopists should not be iv and I produced a DVD with over 400 endoscopy drug users.’ Referring to the dual role of per- videos and stills, which is still available and forming a procedure and also administering remains for me a great resource for Powerpoint the iv sedation. Holding down a child should presentations etc. This textbook has many other never be part of an endoscopy, nor should videos on the accompanying webpage if you are