Therapeutic Gastrointestinal Endoscopy in Pediatric Patients

Therapeutic Gastrointestinal Endoscopy in Pediatric Patients Carmen G. Rostion, Cecilia Castillo, Roque Saenz, Carlos Harz, Carlos Reyes, Raul Prieto, Eduardo Valdivieso, Hugo Richter, Claudio Navarrete Introduction: Pediatric gastrointestinal disorders, occasionally require interventional gastrointestinal endoscopy procedures, to solve congenital or acquired clinical conditions. Its use has increased considerably, due to the development of new and better technological resources and cares, usually extrapolated not only from diagnostic, but also therapeutic endoscopic resources in adult population. Biliary atresia, pancreatic cystic fibrosis, Hirschprung disease and congenital disorders (imperforated anus and esophageal atresia v.g), demand new diagnostic and therapeutic skills. Aim: To evaluate our cumulative experience, in minimally invasive treatment among children. Patients and Method: We present a consecutive series of therapeutic endoscopic procedures in pediatric population (0 to 15 years) recruited from January 2003 to November 2005., in our Unit located at Santiago Chile. After informed consent was obtained from parents, under general anesthesia or titrated sedation with propofol, the endoscopic procedure was performed, utilizing pediatric Olympus instruments. Clinical and endoscopic data, were collected using an Epi Info 2002 computerized database, which includes besides photo images and video-records. Results: 82 therapeutic endoscopic procedures, among 75 patients (40 women and 35 men), aged between 0 and 15 years, refered from Primary Care Hospitals, were done. ERCP in 22 cases (2 liver transplant patients), 12 percutaneous gastrostomies, 8 endoscopic treatment of esophageal varices (6 band ligations and 2 variceal sclerosis), esophageal dilatation in 8 cases (1 achalasia and 7 benign estenosis), intra gastric baloon in 4 obese patients, 6 colonic polypectomies (juvenile polyps). APC in 3 cases of congenital tracheoesophageal fistulae, 3 foreign bodies extraction only, (this procedure is usually performed in the urgency department), positioning of nasoyeyunal tube in 3 cases, endoscopic drainage of 2 gastro-duodenal duplications and 1 pancreatic pseudocyst. 73 patients did well. One patient had recurrence of the tracheoesophageal fistulae, after application of APC and went to surgery. There was a casualty, as consequence of air embolism. Discussion: Minimally invasive gastrointestinal endoscopy procedures appear like complex interventions, but they are becoming a necessary therapeutic resource in the pediatric population. We present our experience in highly selected pediatric patients, referred to our Unit from several Primary Care Hospitals. 97,5% of the cases were solved endoscopically. There was a casualty in this series.