1
|
Iwama I, Nambu R, Nakayama Y. Small bowel endoscopy for children: Collaboration of capsule endoscopy and device-assisted enteroscopy. Dig Endosc 2022. [PMID: 36576231 DOI: 10.1111/den.14511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 12/26/2022] [Indexed: 12/29/2022]
Abstract
Capsule endoscopy (CE) and balloon-assisted enteroscopy (BAE) have become indispensable techniques for the diagnosis and management of small bowel disease in both adult and pediatric cases. However, relevant differences exist in the indications between these cohorts, with body weight and age having particular relevance in decisions for the latter. Both CE and BAE are designed for adult physique and they were not widely used among children. In addition, the types of small intestinal diseases differ between adults and children, and consequently, the indications also differ between them. This review focuses on the issues relevant to pediatric cases and describes the practical application of endoscopy in clinical practice. In conclusion, although there are age and weight restrictions, both CE and BAE are safe and useful devices for use in children, and their indications for use in children are likely to expand in the future.
Collapse
Affiliation(s)
- Itaru Iwama
- Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama, Japan
| | - Ryusuke Nambu
- Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama, Japan
| | - Yoshiko Nakayama
- Department of Pediatrics, Shinshu University School of Medicine, Nagano, Japan
| |
Collapse
|
2
|
Li BR, Sun T, Li J, Zhang YS, Ning SB, Jin XW, Zhu M, Mao GP. Primary experience of small bowel polypectomy with balloon-assisted enteroscopy in young pediatric Peutz-Jeghers syndrome patients. Eur J Pediatr 2020; 179:611-617. [PMID: 31863304 DOI: 10.1007/s00431-019-03534-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 11/19/2019] [Accepted: 11/20/2019] [Indexed: 01/13/2023]
Abstract
For Peutz-Jeghers syndrome (PJS) patients, small bowel polyps develop and result in symptoms at an early age. Balloon-assisted enteroscopy (BAE) is verified as a safe and efficient choice to evaluate and remove small intestinal polyps in adult PJS. But the safety of BAE, especially BAE-facilitated polypectomy for young pediatrics, is little known. This prospective study focused on the effectiveness and safety of BAE-facilitated polypectomy in small bowel for young pediatric PJS. PJS patients (aged 0-14 years old) with BAE (including both single-balloon and double-balloon enteroscopies) were included from 1 September 2012 to 30 April 2018. The demographic data, medical history, and details of BAE were recorded. BAE-related complications and symptom relief after BAE were evaluated and compared between the PJS patients aged 5-10 years old (the younger pediatric group) and those aged 11-14 years old (the older pediatric group). A total of 41 pediatric PJS patients (5-14 years old) subjected to 82 BAEs were included. BAE-facilitated polypectomy was performed for 33 children (80.5%), and 242 polyps in small bowel were removed. For 10 (24.4%) patients, one or more giant polyps (maximum diameter larger than 5 cm) were removed. For eight patients, no polypectomy was done as no polyps were observed (six subjects) or not suitable for BAE-facilitated polypectomy (two subjects) because of high risk of perforation. The complication rates of BAE and BAE-facilitated polypectomy were 1.2% (1/82) and 1.8% (1/55), and the symptom relief rate was 70.8% (17/24). Compared with the older pediatric group, the younger pediatric group showed no increased BAE complication rate (0.0% vs. 5.0%, p = 0.488) and a comparable rate of symptom relief after BAE therapy (80.8% vs. 55.6%, p = 0.356).Conclusion: BAE-facilitated polypectomy in young pediatric PJS is safe and effective.What is known:• Small bowel evaluation and prophetic polypectomy are important for pediatric PJS patients to avoid polyp-related intussusception, obstruction, and bleeding.• BAE polypectomy was a recommended intervention for removing small bowel polyps in adult PJS patients.What is new:• BAE-facilitated small bowel polypectomy is safe and effective for young pediatric PJS, even for those aged less than 10 years old.
Collapse
Affiliation(s)
- Bai-Rong Li
- Department of Gastroenterology, Air Force Medical Center, The Fourth Military Medical University, PLA, NO.30 Fucheng Road, Beijing, 100023, China
| | - Tao Sun
- Department of Gastroenterology, Air Force Medical Center, The Fourth Military Medical University, PLA, NO.30 Fucheng Road, Beijing, 100023, China
| | - Jing Li
- Department of Gastroenterology, Air Force Medical Center, The Fourth Military Medical University, PLA, NO.30 Fucheng Road, Beijing, 100023, China
| | - Yan-Shuang Zhang
- Department of Gastroenterology, Air Force Medical Center, The Fourth Military Medical University, PLA, NO.30 Fucheng Road, Beijing, 100023, China
| | - Shou-Bin Ning
- Department of Gastroenterology, Air Force Medical Center, The Fourth Military Medical University, PLA, NO.30 Fucheng Road, Beijing, 100023, China.
| | - Xiao-Wei Jin
- Department of Gastroenterology, Air Force Medical Center, The Fourth Military Medical University, PLA, NO.30 Fucheng Road, Beijing, 100023, China
| | - Ming Zhu
- Department of Gastroenterology, Air Force Medical Center, The Fourth Military Medical University, PLA, NO.30 Fucheng Road, Beijing, 100023, China
| | - Gao-Ping Mao
- Department of Gastroenterology, Air Force Medical Center, The Fourth Military Medical University, PLA, NO.30 Fucheng Road, Beijing, 100023, China
| |
Collapse
|
3
|
Hagiwara SI, Kudo T, Kakuta F, Inoue M, Yokoyama K, Umetsu S, Iwama I, Yodoshi T, Tatsuki M, Shimizu T, Nakayama Y. Clinical Safety and Utility of Pediatric Balloon-assisted Enteroscopy: A Multicenter Prospective Study in Japan. J Pediatr Gastroenterol Nutr 2019; 68:306-10. [PMID: 30444835 DOI: 10.1097/MPG.0000000000002181] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The benefit of balloon-assisted enteroscopy (BAE) had been recently documented in pediatric patients, but previous reports are based on single institution experiences. We evaluated the feasibility of pediatric BAE in 8 tertiary referral hospitals throughout Japan. METHODS This was a prospective, multi-institutional study. Patients younger than 18 years were enrolled between April 2014 and March 2017 to undergo double-balloon or single-balloon enteroscopy. Data were collected prospectively using a standardized questionnaire. RESULTS We enrolled 79 pediatric patients (96 procedures, 70 boys, 26 girls; median age 12.7 years, range 1-17 years). Antegrade (oral-route) BAE was performed in 20 procedures (lowest body weight 12.9 kg, youngest age 3.7 years), and retrograde (anal-route) BAE in 76 (lowest body weight 10.8 kg, youngest age 1.6 years). Severe adverse events were associated with BAE in 2 patients: 1 with hemorrhage due to polypectomy and 1 with pancreatitis after double-balloon endoscopic retrograde cholangioscopy. No intestinal perforation was reported. Procedure duration of oral-route BAE for diagnosis was significantly longer than anal-route for diagnosis (P < 0.001). The overall diagnostic yield for rectal bleeding/positive fecal occult blood test and abdominal pain was 48%. Among 40 patients referred for diagnosis who did not undergo capsule endoscopy, diagnoses were confirmed in 17 (42.5%) patients after BAE. CONCLUSIONS This prospective multicenter observational study documents the efficacy of BAE in pediatric patients.
Collapse
|
4
|
Di Nardo G, Calabrese C, Conti Nibali R, De Matteis A, Casciani E, Martemucci L, Pagliaro G, Pagano N. Enteroscopy in children. United European Gastroenterol J 2018; 6:961-969. [PMID: 30228882 PMCID: PMC6137589 DOI: 10.1177/2050640618789853] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 06/26/2018] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Device-assisted enteroscopy is a new endoscopic technique for the evaluation of small bowel in adults and children. Data in pediatric population are limited. This review aims to identify diagnostic and therapeutic benefits of enteroscopy in children. METHODS We have analysed paediatric literature on device-assisted enteroscopy focusing on indications, technical aspects and complications, with attention given to adult publications that may be applicable to the paediatric population. RESULTS Obscure gastrointestinal bleeding, Crohn's disease and small bowel polyps are the main indications of enteroscopy in children. Device-assisted enteroscopy has high diagnostic yield for the main paediatric indications, but MR-enterography and capsule endoscopy should be used beforehand in diagnostic work-up to better identify candidates for enteroscopy and to improve its diagnostic and therapeutic yield. Major complications are rare and mostly related to therapeutic procedures. CONCLUSION Despite limited data in the paediatric population, device-assisted enteroscopy represents a useful and safe endoscopic technique in children. Its use, combined with MR-enterography and capsule endoscopy, allows identification and treatment of many of the small bowel paediatric diseases with a low risk of complications.
Collapse
Affiliation(s)
- Giovanni Di Nardo
- Pediatric Gastroenterology Unit, Santobono-Pausilipon Children’s Hospital, Naples, Italy
- International Hospital Salvator Mundi – UPMC, Rome, Italy
| | - Carlo Calabrese
- Department of Medical and Surgical Sciences, University of Bologna, St. Orsola-Malpighi Hospital, Bologna, Italy
| | | | - Arianna De Matteis
- Department of Translational Medical Science, Section of Pediatrics, University Federico II, Naples, Italy
| | - Emanuele Casciani
- International Hospital Salvator Mundi – UPMC, Rome, Italy
- Department of Emergency Radiology, Sapienza University of Rome, Rome, Italy
| | - Luigi Martemucci
- Pediatric Gastroenterology Unit, Santobono-Pausilipon Children’s Hospital, Naples, Italy
| | - Giuseppe Pagliaro
- Pediatric Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Nico Pagano
- Department of Medical and Surgical Sciences, University of Bologna, St. Orsola-Malpighi Hospital, Bologna, Italy
| |
Collapse
|
5
|
Ivano FH, Villela IR, Miranda LFD, Nakadomari TS. ANALYSIS OF DOUBLE BALLOON ENTEROSCOPY: INDICATIONS, FINDINGS, THERAPEUTIC AND COMPLICATIONS. Arq Bras Cir Dig 2017; 30:83-87. [PMID: 29257840 PMCID: PMC5543783 DOI: 10.1590/0102-6720201700020002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 09/13/2016] [Indexed: 12/22/2022]
Abstract
Background: The double balloon enteroscopy is an important method for the endoscopic approach of the small bowel that provides diagnosis and therapy of this segment’s disorders, with low complication rate. Aim: Analysis of patients undergoing double balloon enteroscopy. The specific objectives were to establish the indications for this method, evaluate the findings by the double balloon enteroscopy, analyze the therapeutic options and the complications of the procedure. Methods: It is a retrospective analysis of 65 patients who underwent double balloon enteroscopy. Results: Sixty-five procedures were performed in 50 patients, 63.1% were women and 36.9% were men. The mean age was 50.94 years. The main indication it was gastrointestinal bleeding, followed by abdominal pain and Crohn’s disease. Most procedures were considered normal. Polyps were the most prevalent finding, followed by angioectasias and duodenitis. In 49.2% of the cases, one or more therapeutic procedures were performed, (biopsy was the most prevalent). There was only one case of acute pancreatitis, which was treated clinically. Conclusion: The enteroscopy is good and safe method for the evaluation of the small bowel, and its main indications are gastrointestinal bleeding and abdominal pain. It has low complications rates and reduces the necessity of surgery.
Collapse
Affiliation(s)
- Flávio Heuta Ivano
- Serviço de Endoscopia, Hospital Sugisawa (Endoscopy Service, Sugisawa Hospital, Curitiba, PR, Brazil
| | - Izabela Rodrigues Villela
- Serviço de Endoscopia, Hospital Sugisawa (Endoscopy Service, Sugisawa Hospital, Curitiba, PR, Brazil
| | - Lívia Fouani de Miranda
- Serviço de Endoscopia, Hospital Sugisawa (Endoscopy Service, Sugisawa Hospital, Curitiba, PR, Brazil
| | - Thaísa Sami Nakadomari
- Serviço de Endoscopia, Hospital Sugisawa (Endoscopy Service, Sugisawa Hospital, Curitiba, PR, Brazil
| |
Collapse
|
6
|
Wang BX, Peng HM. Double balloon enteroscopy combined with laparoscopy for diagnosis and treatment of Meckel's diverticulum in children. Shijie Huaren Xiaohua Zazhi 2016; 24:3717-3722. [DOI: 10.11569/wcjd.v24.i25.3717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM To explore the value of double-balloon enteroscopy (DBE) combined with laparoscopy for diagnosis and treatment of Meckel's diverticulum (MD) in children.
METHODS Clinical data for 15 children with agnogenic hematochezia treated at our department from October 2013 to October 2015 were retrospectively analyzed. Despite recurrent bleeding, no bleeding lesions were found by conventional gastroscopy, colonoscopy, radionuclide 99mTc scanning imaging and blood biochemical examination. MD was confirmed by anal DBE examination under tracheal intubation and intravenous anesthesia. Resection of Meckel's diverticulum and intestinal anastomosis were performed with the assistance of laparoscopy.
RESULTS By anal DBE, 15 children with unexplained bleeding were found to have ileal MD about 30-90 cm away from the ileocecal valve, 5 of which had diverticulum ulcer. MD resection and intestinal anastomosis were performed immediately with the assistance of laparoscopy, and postoperative pathological diagnosis was in accordance with clinical diagnosis.
CONCLUSION DBE examination is safe and reliable for diagnosis of MD in children. DBE combined with laparoscopy can overcome the difficulty of preoperative diagnosis to avoid blind laparotomy and lead to small trauma. Therefore, double-balloon enteroscopy combined with laparoscopic treatment has important clinical value in the diagnosis and treatment of MD in children.
Collapse
|
7
|
Abstract
Deep small bowel enteroscopy is a safe procedure that has revolutionized the strategy for diagnosis and treatment of small bowel diseases. However, enteroscopy-associated adverse events are more common compared with standard endoscopy. Prevention, early detection, and effective intervention are crucial in reducing the adverse event severity and improving outcomes. In this article, how to safely perform enteroscopy, avoid adverse events, detect adverse events early, and accomplish effective treatments are discussed. This knowledge can serve as a continuing quality improvement process to reduce the risk of future adverse events and improve the overall quality of endoscopy.
Collapse
Affiliation(s)
- Disaya Chavalitdhamrong
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, University of Florida, Gainesville, FL, USA
| | - Douglas G Adler
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Utah School of Medicine, 30 North 1900 East 4R 118, Salt Lake City, UT 84132, USA
| | - Peter V Draganov
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, University of Florida, Gainesville, FL, USA.
| |
Collapse
|
8
|
Parra-Blanco A, Ruiz A, Alvarez-Lobos M, Amorós A, Gana JC, Ibáñez P, Ono A, Fujii T. Achieving the best bowel preparation for colonoscopy. World J Gastroenterol 2014; 20:17709-17726. [PMID: 25548470 PMCID: PMC4273122 DOI: 10.3748/wjg.v20.i47.17709] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 11/11/2014] [Indexed: 02/06/2023] Open
Abstract
Bowel preparation is a core issue in colonoscopy, as it is closely related to the quality of the procedure. Patients often find that bowel preparation is the most unpleasant part of the examination. It is widely accepted that the quality of cleansing must be excellent to facilitate detecting neoplastic lesions. In spite of its importance and potential implications, until recently, bowel preparation has not been the subject of much study. The most commonly used agents are high-volume polyethylene glycol (PEG) electrolyte solution and sodium phosphate. There has been some confusion, even in published meta-analyses, regarding which of the two agents provides better cleansing. It is clear now that both PEG and sodium phosphate are effective when administered with proper timing. Consequently, the timing of administration is recognized as one of the central factors to the quality of cleansing. The bowel preparation agent should be administered, at least in part, a few hours in advance of the colonoscopy. Several low volume agents are available, and either new or modified schedules with PEG that usually improve tolerance. Certain adjuvants can also be used to reduce the volume of PEG, or to improve the efficacy of other agents. Other factors apart from the choice of agent can improve the quality of bowel cleansing. For instance, the effect of diet before colonoscopy has not been completely clarified, but an exclusively liquid diet is probably not required, and a low-fiber diet may be preferable because it improves patient satisfaction and the quality of the procedure. Some patients, such as diabetics and persons with heart or kidney disease, require modified procedures and certain precautions. Bowel preparation for pediatric patients is also reviewed here. In such cases, PEG remains the most commonly used agent. As detecting neoplasia is not the main objective with these patients, less intensive preparation may suffice. Special considerations must be made for patients with inflammatory bowel disease, including safety and diagnostic issues, so that the most adequate agent is chosen. Identifying neoplasia is one of the main objectives of colonoscopy with these patients, and the target lesions are often almost invisible with white light endoscopy. Therefore excellent quality preparation is required to find these lesions and to apply advanced methods such as chromoendoscopy. Bowel preparation for patients with lower gastrointestinal bleeding represents a challenge, and the strategies available are also reviewed here.
Collapse
|
9
|
Cui J, Huang LY, Lin SJ, Yi LZ, Wu CR, Zhang B. Small intestinal vascular malformation bleeding: A case report with imaging findings. World J Gastroenterol 2014; 20:14076-14078. [PMID: 25320550 PMCID: PMC4194596 DOI: 10.3748/wjg.v20.i38.14076] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 04/29/2014] [Accepted: 06/23/2014] [Indexed: 02/06/2023] Open
Abstract
The small intestine is approximately 5-6 m long and occupies a large area in the abdominal cavity. These factors preclude the use of ordinary endoscopy and X-ray to thoroughly examine the small intestine for bleeding of vascular malformations. Thus, the diagnosis of intestinal bleeding is very difficult. A 47-year-old man presented at the hospital 5 mo ago with dark stool. Several angiomas were detected by oral approach enteroscopy, but no active bleeding was observed. Additionally, no lesions were detected by anal approach enteroscopy; however, gastrointestinal tract bleeding still occurred for an unknown reason. We performed an abdominal vascular enhanced computed tomography examination and detected ileal vascular malformations. Ileum angioma and vascular malformation were detected by a laparoscopic approach, and segmental resection was performed for both lesions, which were confirmed by pathological diagnosis. This report systemically emphasizes the imaging findings of small intestinal vascular malformation bleeding.
Collapse
|