Therapeutic Upper Gastrointestinal Endoscopy in Pediatric Gastroenterology

Abstract

This paper seeks to give a broad overview of pediatric upper gastrointestinal (GI) pathologies that we are now able to treat endoscopically, acquired or congenital, and we hope this delivers the reader an impression of what is increasingly available to pediatric endoscopists and their patients.

Keywords: bleeding; emergency; endoscopy; foreign body (FB); pediatric; reflux; therapeutic; varices.

Figure 1

(A–E) Endoscopic treatment of variceal bleeding. (A) Banding of esophageal varices. (B) Echo-endoscopic vision of needle injection of an esophageal varix. (C) Injection of glue into a fundal varix. (D) An inadvertent introduction of glue into the biopsy channel is prevented by cutting the catheter tip off. (E) Banding of jejunal varix.

Figure 2

(A–D) Over the scope clip (OTSC^®). (A) OTSC^® attached to the tip of the endoscope. (B) Grasping device of the OTSC^®. (C) OTSC^® with its effective anchor mechanism. (D) Mucosal healing after OTSC^® application.

Figure 3

(A–D) Hemospray^®. (A) Hemospray^® device. (B) Activation of the coagulation cascade by Hemospray^® results in immediate clotting. (C,D) Significant GI bleeding before (A) and after Hemospray^® procedure (B).

Figure 4

(A–E) Ingestion of a pointed foreign body. (A,B). Abdominal x-ray of a pointed foreign body ingested by a 5-year old child. (C) Foreign body in the mid-duodenum. (D) FB after successful extraction with a retrieval forceps. (E) Foreign body (pin to fasten clothing) which has been grasped via a polypectomy snare and withdrawn into a protector hood.

Figure 5

(A–D) Bezoars. (A) Bezoar seen at endoscopy. (B) Surgical removal of the bezoar from the same patient. Endoscopic removal wasn't possible. (C) A large bezoar removed. (D) Bezotriptor/Lithotriptor device.

Figure 6

(A–E) Endocinch^® and full thickness Plicator^® (Ndo-Surgical). (A) Endoscopic gastroplication with a zig-zag stich when applied with an Endocinch^® sewing maching. (B,C) View (J maneuver) of a lax GO junction in a child with major reflux before (A) and after (B) application of stitch with the EndoCinch^®. (D) Application of a full Thickness Plicator^® (Ndo-Surgical). (E) After application of the full Thickness Plicator^® (Ndo-Surgical).

Figure 7

The Stretta^® procedure.

Figure 8

(A,B) Dilatation device. (A) Bougie dilator (Savary-Gilliard). (B) Balloon dilator.

Figure 9

(A–D) Fully covered, self-expandable metal stent (FCSEMS) with the courtesy of Prof. Jérôme Viala, Robert-Debré University Hospital, Paris, France. (A) Insertion of a FCSEMS the esophagus via a guide-wire. (B) FCSEMS after expansion. (C) FCSEMS placement in a 12 year old child after Toupet perforation. (D) Displacement of the stent in the stomach, requiring insertion of a longer stent with afterwards satisfying hermeticism and closure of the perforation.

Figure 10

(A,B) Peroral Endoscopic myotomy (POEM). (A) POEM procedure: Incision of the submucosal bleb to create a submucosal tunnel. (B) Myotomie during POEM procedure.

Figure 11

(A,B) Laparoscopic-assisted percutaneous endoscopic jejunostomy (LAPEJ). (A) Laparoscopic view of the proximal jejunum pulled to the abdominal wall by PEG tube insertion. (B) Endoscopic view of the Corflo in the jejunum.

Figure 12

(A–H) Drainage of pancreatic pseudocysts. (A) Trans-gastric linear endo-ultrasound needle puncture of a pancreatic pseudocyst. The linear needle can be seen as a straight white line in the upper part of the picture. (B) The indentation into the gastric wall can be seen easily identifying the position of the pseudocyst. (C) Creation of a cauterized entry from the stomach into the cyst by using and endoknife and sphincterotome: After endo-ultrasound has identified the cyst and a site which is free from gastric vessels, an endoknife followed by a sphincterotome (tapertome is best) is used to create a cauterized entry point from the stomach in to the cyst. Adrenaline can be injected prior to the incision to further diminish the possibility of hemorrhage during incision. (D) Grasping forceps are used to manipulate the stents [pig-tailed (blue) or straight (white)] through the gastro-cystostomy that was created. (E) Self-expanding metal stents. (F) The stents are endoscopically observed in the pseudocyst, and membranes between loculations can be punctured as necessary. (G) The endoscope is withdrawn from the pseudocyst. (H) The endoscope is withdrawn from the stomach and the gastro-cystostomy is left in place.