Practical Pediatric Gastrointestinal Endoscopy E-Book

George Gershman

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 806

Veröffentlichungsjahr: 2021

Beschreibung

PRACTICAL PEDIATRIC GASTROINTESTINAL ENDOSCOPY The reference text for all those practicing diagnostic and therapeutic pediatric endoscopy - trainees, trainers, specialist endoscopists, gastroenterologists and hepatologists alike. Practical Pediatric Gastrointestinal Endoscopy, 3rd Edition provides a comprehensive and up-to-date exploration for the performance of endoscopy in infants, children and young adults. Written in the form of a complete "how to" manual and filled with step-by-step instructions, this book seeks to bring newcomers to the field of pediatric gastrointestinal endoscopy quickly up to speed. The book is also highly useful for experienced specialist endoscopists and gastroenterologists to brush up on best practice in standard techniques and explore advanced topics in the field. Practical Pediatric Gastrointestinal Endoscopy highlights the substantial and important differences between performing an endoscopy on a mature adult and performing one in a pediatric patient. The differences discussed include: * GI pathology * Subtleties of diagnostic technique specific to children * Application of therapeutic endoscopy to specifically pediatric scenarios * Anesthesia and sedation * Training and skill maintenance * Sophisticated endoscopic techniques adapted from adult endoscopy to children and those techniques specifically orientated to problems and diseases mainly encountered in childhood This guide is becoming an essential companion for those of us providing diagnostic and therapeutic endoscopy for children in the world today and opens the door to future possibilities in this ever-evolving field.

Leseprobe

Table of Contents

Cover

Title Page

Copyright Page

Personal statements

Contributors

About the Companion Website

Part One: Pediatric Endoscopy Setting

1 Introduction

2 History of pediatric gastrointestinal endoscopy

The precursors

The fiberscope

Training

Evolution

Conclusion

REFERENCES

3 The endoscopy unit

Unit design

Unit management

Equipment

Conclusion

REFERENCES

4 Pediatric procedural sedation and general anesthesia for gastrointestinal endoscopy

Introduction

Definitions/spectrum of sedation to general anesthesia

Assessing risk in the pediatric patient

Preparation

Staffing and environment preparation

During sedation and monitoring

Postsedation care

Conclusion

FURTHER READING

5 Pediatric endoscopy training and ongoing assessment

Introduction

Training

Assessment

Conclusion

REFERENCES

6 Recertification and revalidation as concepts in pediatric endoscopy

REFERENCES

7 The role of the Global Rating Scale in pediatric endoscopy

Introduction

Pediatric endoscopy GRS

The future

REFERENCES

FURTHER READING

8 Quality indicators as a critical part of pediatric endoscopy provision

Introduction

Conclusion

REFERENCES

9 e‐learning in pediatric endoscopy

USEFUL WEBSITES

Part Two: Diagnostic Pediatric Endoscopy

10 Indications for gastrointestinal endoscopy in childhood

Introduction

Diagnostic endoscopy

Therapeutic indications for endoscopy

11 Diagnostic upper gastrointestinal endoscopy

Introduction

Indications for EGD

Assembling the equipment and preprocedure check‐up

Endoscope handling

Preparation for esophageal intubation

Techniques of esophageal intubation

Exploration of the esophagus, stomach, and duodenum

Biopsy technique

pH and pH impedance probe placement

Complications

Uncommon, incidental, and rare findings during EGD

FURTHER READING

12 Pediatric ileocolonoscopy

Bowel preparation for colonoscopy

Indications for ileocolonoscopy

Contraindications for ileocolonoscopy

Equipment

Informed consent and preprocedure preparation

Specifics of sedation for colonoscopy

Embryology of the colon relative to ileocolonoscopy

Endoscopic anatomy of the colon and terminal ileum

Torque steering technique – the key to successful ileocolonoscopy

Technique of ileocolonoscopy

Complications

Common pathology: rectal bleeding

Rare pathology

FURTHER READING

13 Handling of specimens and orientation of biopsies

Introduction

Specimen handling in the endoscopy unit

Specimen handling in the histopathology laboratory

REFERENCES

14 Enteroscopy

Introduction

Double‐balloon enteroscopy technique

Single‐balloon enteroscopy

Spiral enteroscopy

Intraoperative or laparoscopy‐assisted enteroscopy

General complications

Conclusion

FURTHER READING

15 Wireless capsule endoscopy

Introduction

Practical approach

Pediatric experience and pathologies

Recent developments

Conclusion

REFERENCES

16 Endoscopic ultrasonography

Introduction

Instruments and technique

Indications in children

EUS features in pediatric diseases

REFERENCES

17 Chromoendoscopy

Indications

Application technique

Recognition of lesions

FURTHER READING

18 Confocal laser endomicroscopy in the diagnosis of pediatric gastrointestinal disorders

Contrast agents

Upper GI tract

Lower GI tract

Conclusion

FURTHER READING

19 High‐risk pediatric endoscopy

Introduction

Patients at high risk for cardiopulmonary and sedation‐related events

Patients at high risk for bleeding

Patients at high risk for perforation

Patients at high risk for endoscopy‐related infections

Risk factors for procedure‐related infections

REFERENCES

Part Three: Pediatric GI Pathologies and the Role of Endoscopy in Their Management

20 Esophagitis

Introduction

Infectious esophagitis

Epidermolysis bullosa

Esophagitis in Crohn's disease

Chemotherapy and radiotherapy‐induced esophagitis

Final considerations

REFERENCES

21 Eosinophilic esophagitis

Introduction

Mucosal biopsy procurement

Assessment of esophageal gross findings

Therapeutic uses for endoscopy

Future alternative devices for mucosal assessment

Acknowledgments

REFERENCES

22 Gastritis and gastropathy

Introduction

Infective gastropathy

Reactive gastropathy

Conclusion

REFERENCES

23 Celiac disease

Introduction

Visual diagnosis, biopsy sampling, handling, and histopathology

Future of endoscopy in pediatric CD

REFERENCES

24 Role of endoscopy in inflammatory bowel disease including scoring systems

Introduction

Diagnosis

Monitoring

Scoring systems

REFERENCES

Part Four: Therapeutic Pediatric Endoscopy

25 Endoscopic management of esophageal strictures

Stricture presentation

Classification

Diagnosis

Differential diagnosis

Treatment

REFERENCES

26 Endoscopic management of caustic ingestion

Introduction

Pathophysiology

Clinical presentation

Assessment and management

Endoscopy

Treatment

Long‐term complications

REFERENCES

27 Pneumatic balloon dilation and peroral endoscopic myotomy for achalasia

Introduction

Diagnosis and management of achalasia

Therapeutic options

Peroral endoscopic myotomy

REFERENCES

28 Endoscopic approaches to the treatment of gastroesophageal reflux disease

Introduction

Endoscopic suturing devices

EsophyX ®

Delivery of radiofrequency energy (Stretta® system)

Gastroesophageal biopolymer injection

Conclusion

FURTHER READING

29 Foreign body ingestion

Introduction

Diagnostic evaluation

Esophageal impaction of a foreign body

Foreign bodies in the stomach and small bowel

Food bolus impaction

Equipment and management approaches for foreign body removal

REFERENCES

30 Non‐variceal endoscopic hemostasis

Introduction

General considerations

Choice of endoscope

Techniques of endoscopic hemostasis

REFERENCES

31 Variceal endoscopic hemostasis

Portal hypertension and variceal formation

Diagnosis, classification, and risk stratification of varices

Primary prophylaxis

Secondary prophylaxis

Gastric varices

REFERENCES

32 Endoscopic approach to obscure gastrointestinal bleeding lesions

Introduction

Classification

Evaluation and management of obscure gastrointestinal bleeding

Diagnostic and therapeutic approach with enteroscopy

Conclusion

REFERENCES

33 Percutaneous endoscopic gastrostomy

Introduction

Indications

Contraindications

Decision to proceed with PEG and preprocedure evaluation

Technique

Postprocedure management

Complications

New uses of the PEG technique

Conclusion

FURTHER READING

34 Single‐stage percutaneous endoscopic gastrostomy

Introduction

Indications

Contraindications

Advantages of single‐stage PEG

Drawbacks

Technique

Postprocedure management

Complications

Useful tips

Materials

Consent

REFERENCES

35 Pediatric laparoscopic‐assisted direct percutaneous jejunostomy

Introduction

Conclusion

FURTHER READING

36 Naso‐jejunal and Gastro‐jejunal tube placement

FURTHER READING

37 Endoscopic retrograde cholangiopancreatography

Introduction

Duodenoscopes and accessories

Performing ERCP in children

Adverse events in pediatric ERCP

Biliary indications for diagnostic and therapeutic ERCP

Pancreatic indications for diagnostic and therapeutic ERCP

Functional biliary sphincter disorder (previously sphincter of Oddi dysfunction; SOD)

Conclusion

FURTHER READING

38 Endoscopic drainage of pancreatic pseudocysts

Pancreatitis

Pancreatic pseudocysts

REFERENCES

39 Duodenal web division by endoscopy

FURTHER READING

40 Polypectomy

Principles of electrosurgery

Snare loops

Routine polypectomy

Complications

FURTHER READING

41 Endomucosal resection

Introduction

High‐magnification chromoscopic colonoscopy

Endoscopic mucosal resection

Clinical recommendations and conclusions

42 Endoscopic management of polyposis syndromes

Introduction and classification

Familial adenomatous polyposis

Juvenile polyposis syndrome

Peutz–Jeghers syndrome

43 Transnasal gastrointestinal endoscopy

Introduction

Preendoscopy preparation

Views and image quality

Duration

Success rates

Patient comfort and preference

Complications and safety profile

Therapeutic use

Future considerations

Conclusion

REFERENCES

44 Endoscopic bariatric approaches

Introduction

Intragastric balloons

Duodenojejunal bypass liner

Conclusion

FURTHER READING

45 Over‐the‐scope clip and full‐thickness resection device

FURTHER READING

46 Endoscopic treatment of gastrointestinal bezoars

REFERENCES

47 Natural orifice transendoluminal surgery

Index

End User License Agreement

List of Tables

Chapter 7

Table 7.1 Pediatric GRS domains and standards (www.thejag.org.uk)

Chapter 10

Table 10.1 Therapeutic indications for EGD

Table 10.2 Indications for therapeutic colonoscopy in children

Chapter 12

Table 12.1 Contraindications to ileocolonoscopy

Table 12.2 Technical specifications of new regular adult colonoscopes

Table 12.3 Technical specifications of new slim colonoscopes

Table 12.4 Technical specifications of new ultra‐slim colonoscopes

Table 12.5 Complications associated with pediatric colonoscopy

Chapter 13

Table 13.1 Artefacts related to biopsy trauma and specimen processing in endo...

Chapter 14

Table 14.1 Diagnostic and therapeutic indications for enteroscopy

Chapter 15

Table 15.1 Potential indications for capsule endoscopy in pediatric patients

Chapter 16

Table 16.1 Commercially available echo‐endoscopes and miniprobes

Table 16.2 Indications for EUS in children

Table 16.3 EUS features in esophageal diseases

Table 16.4 EUS features in gastric pathology

Table 16.5 EUS features of the cystic and mass lesions of the pancreas and bi...

Chapter 17

Table 17.1 Types of staining

Table 17.2 “Surface” guidelines for chromoendoscopy in ulcerative colitis

Chapter 20

Table 20.1 Endoscopic classification of esophageal candida

Chapter 22

Table 22.1 Classification of gastropathy. Gastritis and gastropathy can be cl...

Chapter 26

Table 26.1 Endoscopic classification of caustic injuries

Chapter 29

Table 29.1 Equipment compatible with a pediatric endoscope (2 mm channel)

Chapter 31

Table 31.1 Classification system for esophageal varices

Chapter 32

Table 32.1 Principal causes of obscure gastrointestinal bleeding in children

Chapter 33

Table 33.1 Tricks of the trade

Chapter 34

Table 34.1 Advantages of single‐stage PEG

Chapter 37

Table 37.1 Duodenoscopes: specification

Table 37.2 Biliary indications for diagnostic and therapeutic ERCP

Table 37.3 ERCP findings in infants with suspected biliary atresia

Table 37.4 Todani classification of choledochal cyst (based on the shape of a...

Table 37.5 Pancreatic indications for diagnostic and therapeutic ERCP

Table 37.6 Role of MRCP and ERCP in children with pancreatic disorders

Table 37.7 Steps of biliary and pancreatic sphincterotomy technique

Table 37.8 Steps of endoscopic marsupialization of duodenal duplication

Chapter 41

Table 41.1a Paris classification of endoscopic lesion morphology

Table 41.1b modified Kudo criteria for the classification of colorectal crypt...

Table 41.2 Classification of common chromoscopic dyes

Chapter 42

Table 42.1 Polyps and polyposis syndromes seen in childhood and associated ge...

Table 42.2 Endoscopic surveillance and screening strategies for polyposis syn...

Chapter 43

Table 43.1 Currently available ultrathin endoscopes

List of Illustrations

Chapter 10

Figure 10.1 Suggested diagnostic algorithm of chronic vomiting. PPI, proton ...

Figure 10.2 Suggested diagnostic algorithm of lower gastrointestinal bleedin...

Figure 10.3 Suggested diagnostic algorithm for chronic abdominal pain.

Figure 10.4 Suggested diagnostic algorithm of chronic diarrhea.

Figure 10.5 Suggested initial management of upper gastrointestinal bleeding....

Chapter 11

Figure 11.1 Control panel handling. The control panel is held by the left fo...

Figure 11.2 The connecting tube behind the thumb balances the weight of the ...

Figure 11.3 Manipulations with the R/L and U/D knobs. The thumb is the main ...

Figure 11.4 Technique of extensive rotation of the control knobs. The middle...

Figure 11.5 The initial phase of esophageal intubation. The endoscopist shou...

Figure 11.6 The root of the tongue appears as a cobblestone texture. It may ...

Figure 11.7 The initial view of the epiglottis. The epiglottis should be fou...

Figure 11.8 The endoscopic anatomy of the larynx: panoramic view.

Figure 11.9 Endoscopic appearance of the vocal cords. A close capture of the...

Figure 11.10 Close‐up view of the crico‐arytenoid cartilages. The esophageal...

Figure 11.11 Side‐view of the groove between the lateral wall of the larynx ...

Figure 11.12 Appearance of the pharyngoepiglottic fold signals to reverse di...

Figure 11.13 Close‐up view of the esophageal orifice.

Figure 11.14 The second physiological narrowing of the esophagus. It does no...

Figure 11.15 The distal esophagus. It tapers down toward the hiatal notch.

Figure 11.16 Z‐line. The junction between the pale esophageal and richer col...

Figure 11.17 Prominent fold of the greater curvature of the stomach. Appeara...

Figure 11.18 Panoramic view of the gastric body. It can be achieved by clock...

Figure 11.19 Gastric angularis. The detailed image of the angularis can be e...

Figure 11.20 Panoramic view of the antrum. At this stage of the procedure, t...

Figure 11.21 Panoramic view of the duodenal bulb. This is useful for correct...

Figure 11.22 Endoscopic mapping of the duodenal bulb during the insertion ph...

Figure 11.23 Mapping of the walls of the duodenal bulb after reduction of th...

Figure 11.24 Appearance of the transitional zone between the duodenal bulb a...

Figure 11.25 Horizontal configuration of the transitional zone between the d...

Figure 11.26 The major duodenal papilla, the hallmark of the second portion ...

Figure 11.27 The major duodenal papilla. The side‐viewing duodenoscope allow...

Figure 11.28 The endoscopic appearance of the duodenum at the level of the l...

Figure 11.29 View of the gastric body during the initial phase of the retrof...

Figure 11.30 Appearance of the cardia after partial withdrawal of the shaft ...

Figure 11.31 Detailed view of the cardia after further withdrawal of the sco...

Figure 11.32 Appearance of the Z‐line signals the end of the withdrawal part...

Figure 11.33 Small squamous papilloma of the middle esophagus.

Figure 11.34 (a) Proximal edge of almost circumferential mass in the distal ...

Figure 11.35 Highly unusual appearance of the gastric mucosa: prominent and ...

Figure 11.36 (a) Acute phase of severe corrosive gastritis. (b) Multiple sca...

Figure 11.37 Pinpoint narrowing of the pylorus induced by the circular mass ...

Figure 11.38 Heterotopic pancreas in the greater curvature of the prepyloric...

Figure 11.39 (a) Sessile hyperplastic polyp in the antrum. (b) Inflammatory ...

Figure 11.40 Burkitt’s lymphoma: multiple ulcerated mass lesions in the stom...

Figure 11.41 Razed, rounded ulcerated lesions with irregular base in the sto...

Figure 11.42 (a) A relatively large active ulcer on the posterior wall of th...

Figure 11.43 (a) Edematous and dilated folds of the duodenum. (b) Numerous w...

Chapter 12

Figure 12.1 Unusually wide‐open anus. This finding is suspicious for spina b...

Figure 12.2 Squamocolumnar junction or dentate line.

Figure 12.3 The longitudinal folds in the distal rectum (columns of Morgani)...

Figure 12.4 Semilunar folds of Houston in the rectum.

Figure 12.5 Typical vascular pattern of the normal rectum.

Figure 12.6 The sigmoid colon. The endoscopic markers of normal sigmoid colo...

Figure 12.7 The angle is sharper when the descending colon extends down belo...

Figure 12.8 The descending colon. The shape of the descending colon is close...

Figure 12.9 The vascular pattern of the descending colon. The stems of the v...

Figure 12.10 The splenic flexure. It is marked by bluish discoloration.

Figure 12.11 The angle between the splenic flexure and transverse colon in r...

Figure 12.12 The transverse colon. The triangular shape is the endoscopic ha...

Figure 12.13 The hepatic flexure. The mucosa of this area is paler and has a...

Figure 12.14 The hepatic flexure, which is dome shaped. The junction between...

Figure 12.15 Appendiceal orifice and “bow and arrow sign”: the imaginary arr...

Figure 12.16 A focal widening or bulging of the circular fold at the upper a...

Figure 12.17 Lumen as a clock face. (a) Scope straight. (b) Tip up deflectio...

Figure 12.18 Slightly depressed groove‐like area and merging folds are the s...

Figure 12.19 The main submucosal veins and their branches. The main vessels ...

Figure 12.20 Common locations of the lumen. (a) The lumen is located at 9 o’...

Figure 12.21 Prominent taenia coli. An appearance of the taenia while approa...

Figure 12.22 Schematic images of: (a) alpha loop, (b) N‐loop and (c) Scope G...

Figure 12.23 Gamma loop in the transverse colon.

Figure 12.24 The ileocecal valve. It is usually located between the 5 o’cloc...

Figure 12.25 The terminal ileum. Velvety texture, yellowish tinge, and lymph...

Figure 12.26 Ulcerative colitis. Diffuse inflammation is typical for ulcerat...

Figure 12.27 The “cecal patch”: a focal inflammation of the appendiceal orif...

Figure 12.28 Severe form of ulcerative colitis. (a) Narrowing of the lumen d...

Figure 12.29 Multiple pseudopolyps. (a,b) Acute phase. (c) Endoscopic remiss...

Figure 12.30 Aphthous ulcer. A small, 4–5 mm, shallow lesion with the rim of...

Figure 12.31 Deep longitudinal ulcers in a patient with Crohn’s disease.

Figure 12.32 (a) Mucosal bridging. (b) Colonic stricture.

Figure 12.33 Allergic colitis. Multiple lymphoid follicles with rim of eryth...

Figure 12.34 Small aphthoid‐like lesions can occasionally be induced by bowe...

Figure 12.35 Numerous lymphoid follicles in the sigmoid colon.

Figure 12.36 Multiple enlarged (more than 3 mm) lymphoid follicles in the te...

Figure 12.37 Six‐year‐old boy with recurrent ileocolonic intussusceptions. I...

Figure 12.38 Sessile juvenile polyp.

Figure 12.39 Pedunculated juvenile polyp.

Figure 12.40 Large juvenile polyp in the descending colon.

Figure 12.41 The “chicken skin” sign. The mucosa around a large juvenile pol...

Figure 12.42 Juvenile polyposis. Multiple juvenile polyps in the rectum and ...

Figure 12.43 Multiple colon polyps in a 5‐year‐old boy with FAP.

Figure 12.44 Adenocarcinoma of the right colon in an 11‐year‐old boy with si...

Figure 12.45 Non‐Hodgkin’s lymphoma of the ileum. The indications for a colo...

Figure 12.46 Langerhans cell histiocytosis of the colon: multiple yellowish ...

Figure 12.47 Large hemangioma of the sigmoid colon in a 3‐year‐old girl with...

Figure 12.48 Angiodysplasia of the colon in a child with recurrent low GI bl...

Figure 12.49 Idiopathic colonic varices of the right colon in a 9‐year‐old b...

Figure 12.50 Congenital colonic varices in a 3‐week‐old baby with hematochez...

Chapter 13

Figure 13.1 (a) GIT biopsies embedded in multicassettes (e.g., ABC). The mac...

Figure 13.2 (a) Gastrointestinal sample embedded on edge, rendering a good v...

Chapter 14

Figure 14.1 Double‐balloon enteroscope system configuration.

Figure 14.2 DBE technique.

Figure 14.3 Double‐balloon tattoo.

Figure 14.4 Polyp detected (a) and removed (b).

Figure 14.5 Multiple angiomas in small bowel.

Figure 14.6 Meckel’s diverticulum.

Figure 14.7 (a) Blue rubber bleb nevus syndrome lesions. (b) Blue rubber ble...

Figure 14.8 Single‐balloon enteroscopy.

Figure 14.9 Spiral enteroscopy outside the patient.

Figure 14.10 Spiral enteroscope advancing intraluminally.

Figure 14.11 Extent of laparoscopic‐assisted enteroscopy.

Figure 14.12 Intraoperative enteroscopy and transillumination of a discrete ...

Chapter 15

Figure 15.1 Occult bleeding from an angiodysplasia.

Figure 15.2 Jejunal Peutz–Jeghers polyp.

Figure 15.3 (a) Crohn’s disease. (b) A follow‐up study in a 16‐year‐old male...

Figure 15.4 CMUSE or diaphragm disease.

Figure 15.5 Lymphoma.

Figure 15.6 Meckel's diverticulum.

Figure 15.7 NSAID lesions.

Figure 15.8 Crohn’s aphthoid ulcers and stricture.

Figure 15.9 Celiac disease.

Figure 15.10 Methods of “front‐loading” the PillCam

TM

onto a gastroscope. (a...

Figure 15.11 Intestinal lymphangiectasia.

Figure 15.12 Intestinal intussusception.

Figure 15.13 Images obtained with an esophageal capsule.

Figure 15.14 Colon capsule.

Figure 15.15 Mechanism for magnetic capsule propulsion.

Chapter 16

Figure 16.1 Ultrasound catheter probe.

Figure 16.2 Front‐loading ultrasound probe.

Figure 16.3 Radial scan ultrasound. Distal tip of echo‐endoscope with balloo...

Figure 16.4 Linear scan ultrasound video endoscope. Distal tip of echo‐endos...

Figure 16.5 The linear probe with advanced aspiration/biopsy needle.

Figure 16.6 EUS of the needle (

double arrow

) advanced into a pancreatic pseu...

Figure 16.7 Orientation of a FNA needle advanced through the operative chann...

Figure 16.8 (a) Esophagus wall; the first inner hyperechoic (bright) layer i...

Figure 16.9 Esophageal anastomotic stenosis: thickening of concentric layers...

Figure 16.10 Esophageal duplication marked by arrow.

Figure 16.11 Congenital stenosis with aberrant cartilaginous remnants (

white

...

Figure 16.12 Gastrointestinal stromal tumor (GIST) (arising from submucosal ...

Figure 16.13 GIST‐FNA. Arrow points toward the FNA within the labeled mass (...

Figure 16.14 Gastric lymphoma (distortion of the gastric wall and enlarged l...

Figure 16.15 Duodenal duplication.

Figure 16.16 Plicate hypertrophy of the stomach related to

Helicobacter pylo

...

Figure 16.17 Duodenal web.

Figure 16.18 Choledocholithiasis: two stones (

arrow

) in the dilated common b...

Figure 16.19 Autoimmune pancreatitis (white arrow pointing at fullness in pa...

Figure 16.20 Pancreatic pseudocyst. (a) Hypoechoic/anechoic cyst (

white arro

...

Chapter 17

Figure 17.1 The tip of a pediatric ERCP catheter pushed through the biopsy c...

Figure 17.2 Endoscopic view of Barrett’s esophagus: (a) plain close view; (b...

Figure 17.3 Endoscopic view of the distal duodenum in a patient with celiac ...

Figure 17.4 Immersion chromoendoscopy after methylene blue spray, without pr...

Figure 17.5 In a patient with familial adenomatous polyposis coli, flat (a) ...

Figure 17.6 Colonic polyps before and after chromoendoscopy. (a) Hyperplasti...

Chapter 18

Figure 18.1 Confocal laser endomicroscope (Pentax).

Figure 18.2 Comparison of confocal images with conventional histological ima...

Figure 18.3 Comparison of confocal images with conventional histological ima...

Figure 18.4 (a) Inflammatory bowel disease showing bifid crypt pattern, cryp...

Figure 18.5 CLE of GVHD showing nuclear debris representing apoptotic bodies...

Chapter 20

Figure 20.1 Friability, edema, and erythema of varying degrees eventually as...

Figure 20.2 Endoscopic characteristics of herpes esophagitis including mucos...

Figure 20.3 Similar characteristics are shown in this figure.

Figure 20.4 In epidermolysis bullosa, narrowing of the esophagus is more pro...

Figure 20.5 Crohn’s esophageal involvement is usually with aphthoid ulcerati...

Figure 20.6 Radiation‐ or chemotherapy‐induced esophagitis can be significan...

Chapter 21

Figure 21.1 Exudate – whitish coating on the esophageal surface. Exudate rep...

Figure 21.2 Circumferential rings along the length of the esophagus. This fi...

Figure 21.3 Mucosal edema and linear furrows. These finding are representati...

Figure 21.4 Longitudinal rent. This split can occur with the passage of the ...

Figure 21.5 Food impaction present in the esophageal lumen. Mucosa is edemat...

Chapter 23

Figure 23.1 (a) Endoscopy with water immersion showing normal villus pattern...

Figure 23.2 (a) Duodenal biopsy specimen with bottom opened and oriented on ...

Chapter 25

Figure 25.1 Complex esophageal stricture secondary to caustic ingestion.

Figure 25.2 Congenital esophageal stenosis with tracheal remnants.

Figure 25.3 (a) Fluoroscopic appearance of a balloon waist. The arrow shows ...

Figure 25.4 Incisions of the scar performed using a needle knife and a cutti...

Figure 25.5 Two‐year‐old boy with complex esophageal stricture due to causti...

Figure 25.6 The Dynamic Stent®.

Figure 25.7 (a) The Dynamic Stent® in correct position. The two radiopaque b...

Chapter 26

Figure 26.1 Grade I corrosive esophagitis with diffuse erythema and minimal ...

Figure 26.2 Grade IIa corrosive esophagitis: extensive mucosal sloughing.

Figure 26.3 Grade IIb of corrosive esophagitis: multiple ulcerations.

Figure 26.4 Corrosive gastritis.

Figure 26.5 Esophageal stricture after lye ingestion.

Figure 26.6 Multiple esophageal strictures two months after caustic ingestio...

Chapter 27

Figure 27.1 Subtypes of achalasia on high‐resolution manometry: (a) I, (b) I...

Figure 27.2 Diagnosis and treatment algorithm based on expert opinion and cu...

Figure 27.3 Rigiflex dilator.

Figure 27.4 Submucosal injection of methylene blue prior to mucosotomy.

Figure 27.5 Lineal mucosal incision.

Figure 27.6 Initial stage of tunnel development.

Figure 27.7 Creation of a tunnel using an electrical knife and pressure from...

Figure 27.8 Completion of the tunnel with exposed circular muscle.

Chapter 28

Figure 28.1 EndoCinch front‐mounted on the endoscope.

Figure 28.2 Suction applied and full‐thickness tissue capture followed by ne...

Figure 28.3 Endoscopic gastroplication. This figure shows the pattern of a z...

Figure 28.4 View (J manoeuver) of a lax GE junction in a child with major re...

Figure 28.5 EndoCinch pediatric series pH efficacy at one year.

Figure 28.6 Significant improvement in the total QOLRAD score one and three ...

Figure 28.7 The Full‐Thickness Plicator.

Figure 28.8 Application of the Full‐Thickness Plicator.

Figure 28.9 Retroverted views of stages of application of the Full‐Thickness...

Figure 28.10 Distal end of the EsophyX device (a) and SerosaFuse fastener (b...

Figure 28.11 Endoscopic images of gastroesophageal valves from two subjects ...

Figure 28.12 Operation times comparing endoscopic, laparoscopic. and open fu...

Figure 29.13 Hospital stay (days) comparing endoscopic, laparoscopic, and op...

Figure 28.14 Total cost comparing endoscopic, laparoscopic, and open fundopl...

Figure 28.15 The Stretta system. Use of a balloon to deliver radiofrequency ...

Figure 28.16 Injection of liquid polymer into the esophageal mucosa. The Ent...

Chapter 30

Figure 30.1 Active bleeding F 1b from a duodenal ulcer.

Figure 30.2 Adherent clot (F 2b) at the base of a gastric ulcer.

Figure 30.3 A flat pigmented spot (F 2c) at the base of a duodenal ulcer.

Figure 30.4 Clear base of a duodenal ulcer (F 3).

Figure 30.5 Single‐use preloaded rotatable two‐pronged clips: a single clip....

Figure 30.6 Over‐the‐scope clip.

Figure 30.7 Delivery system.

Chapter 31

Figure 31.1 Large esophageal varices before and after band ligation.

Figure 31.2 (a) EUS varices preinjection. (b) EUS varices with needle.

Figure 31.3 Varices being banded.

Figure 31.4 Varices with EUS probe.

Figure 31.5 Cutting the catheter after glue injection prior to removal to pr...

Chapter 32

Figure 32.1 Algorithm for the management of OGIB in children. CE, capsule en...

Chapter 33

Figure 33.1 Finger indentation of the anterior gastric wall.

Figure 33.2 Schematic representation of the safe tract technique. In this ca...

Figure 33.3 Placement of the blue guidewire through the catheter. A sufficie...

Figure 33.4 Internal view of a PEG tube alongside the anterior gastric wall....

Figure 33.5 (a) Buried bumper syndrome. The gastrostomy bumper is no longer ...

Chapter 34

Figure 34.1 Indentation.

Figure 34.2 Transillumination.

Figure 34.3 Marking the site.

Figure 34.4 T‐fastener device.

Figure 34.5 Insert the preloaded needle.

Figure 34.6 Release the suture thread.

Figure 34.7 Bend the locking strip and push the inner hub.

Figure 34.8 Pull the T‐bar against the mucosa.

Figure 34.9 Slide and close suture lock.

Figure 34.10 Gastric view of gastropexy.

Figure 34.11 Abdominal view of gastropexy.

Figure 34.12 Local anesthesia injection.

Figure 34.13 Make the incision.

Figure 34.14 Introduce the safety needle.

Figure 34.15 Activate safety collar.

Figure 34.16 Remove the safety needle while introducing the guidewire.

Figure 34.17 Remove the safety needle while introducing the guidewire.

Figure 34.18 Dilation of stoma tract.

Figure 34.19 Endoscopic view of dilator.

Figure 34.20 Remove the dilator.

Figure 34.21 Measure the length.

Figure 34.22 Continue dilation.

Figure 34.23 Keep the endoscopic view.

Figure 34.24 Rotate the dilator central part to release the peel‐away sheath...

Figure 34.25 Rotate the dilator central part to release the peel‐away sheath...

Figure 34.26 Remove the dilator and the guidewire, leaving the peel‐away she...

Figure 34.27 Advance the button while peeling the sheath.

Figure 34.28

Figure 34.29

Figure 34.30 Endoscopic view of the button revealed as the sheath is peeled ...

Figure 34.31

Figure 34.32

Figure 34.33 Peel the sheath down to the skin and remove it.

Figure 34.34

Figure 34.35

Figure 34.36 Gastric view of the single‐stage PEG.

Figure 34.37 Abdominal view.

Chapter 35

Figure 35.1 Laparoscopic view of endoscopic light source seen through the sm...

Figure 35.2 A Johan instrument is used to occlude the jejunum distal to the ...

Figure 35.3 Simultaneous laparoscopic and endoscopic view of trocar inserted...

Figure 35.4 Endoscopic view of wire grasped by biopsy forceps.

Figure 35.5 PEJ placed – endoscopic (a) and laparoscopic (b) views showing P...

Chapter 36

Figure 36.1 Endoscopic view of the feeding tube beyond the pylorus.

Chapter 37

Figure 37.1 Long common channel with choledochal cyst.

Figure 37.2 Long common channel with choledochal cyst and choledochocele.

Figure 37.3 Two‐year‐old child with rhabdomyosarcoma. Cholangioscopic view w...

Figure 37.4 Fluoroscopic view of a 4‐year‐old child with rhabdomyosarcoma du...

Figure 37.5 Primary sclerosing cholangitis.

Figure 37.6 Fourteen‐year‐old child with traumatic bile leak.

Figure 37.7 Seven‐year‐old liver transplant recipient with anastomotic stric...

Figure 37.8 Sixteen‐year‐old liver transplant recipient with acute liver fai...

Figure 37.9 Fourteen‐year‐old liver transplant recipient with two plastic bi...

Figure 37.10 Fourteen‐year‐old liver transplant recipient with fully covered...

Figure 37.11 Thirteen‐year‐old child with pancreas divisum and cystic fibros...

Figure 37.12 Sixteen‐year‐old child with stent placement cystgastrostomy for...

Chapter 38

Figure 38.1 Transgastric linear endo‐ultrasound needle puncture of a pancrea...

Figure 38.2 The indentation into the gastric wall can be seen easily identif...

Figure 38.3 After endo‐ultrasound has identified the cyst and a site which i...

Figure 38.4 Grasping forceps are used to manipulate the stents (pig‐tailed [...

Figure 38.5 The stents are endoscopically observed in the pseudocyst, and me...

Figure 38.6 The endoscope is withdrawn from the pseudocyst.

Figure 38.7 The endoscope is withdrawn from the stomach and the gastrocystos...

Chapter 39

Figure 39.1 Simple balloon dilation of web/diaphragm can be effective alone ...

Figure 39.2 Guidewire of endoballoon passing through small apperture in web/...

Figure 39.3 Endoballoon has been inflated and gentle traction allows membran...

Figure 39.4 Dual‐channel endoscope allows deployment of the endoknife to inc...

Figure 39.5 Adequate luminal patency achieved.

Chapter 40

Figure 40.1 Different types of alternating RF currents and specific tissue r...

Figure 40.2 Temperature‐related tissue destruction always induced by RF curr...

Figure 40.3 Snare preparation before polypectomy: marking of the so‐called c...

Figure 40.4 Squeezing pressure. A 15 mm retraction of the wire into the plas...

Figure 40.5 The polyp is within the wire loop.

Figure 40.6 The snare is fully closed. Avoid excessive force to prevent ampu...

Figure 40.7 Mechanical prophylaxis of bleeding with endo‐clips.

Figure 40.8 (a) Tripod forceps. (b) Roth net.

Figure 40.9 Hemostasis with argon plasma coagulation.

Chapter 41

Figure 41.1 (

Top left

) High‐definition white light images of a proximal asce...

Figure 41.2 (

Left

) Conventional high‐definition white light views of a later...

Figure 41.3

(

Left

) Endoscopic mucosal resection of the lesion is indicated (...

Figure 41.4 (

Top left

) Conventional high‐definition white light imaging of a...

Figure 41.5

(

Left

) Conventional white light views of the distal descending c...

Figure 41.6 (

Left/right

) Confocal laser scanning endomicroscopic imaging usi...

Figure 41.7 (

Left/right

) High‐power hematoxylin and eosin staining of the ba...

Figure 41.8

(

Left

) High‐definition white light imaging of the distal sigmoid...

Figure 41.9

(

Left

) High‐magnification (100×) chromoscopic colonoscopy (indig...

Chapter 42

Figure 42.1 Colonoscopic appearance of multiple adenomas >1 cm meriting refe...

Figure 42.2 (a) Multiple pedunculated polyps in a 6‐year‐old Caucasian femal...

Figure 42.3 (a) Multiple large gastric polyps in the stomach of a 15 year ol...

Chapter 43

Figure 43.1 (a) Suggested sitting method: TNE insertion pathway below the in...

Figure 43.2 Suggested optimal area to pass the transnasal endoscope after in...

Figure 43.3 Suggested midline area to pass transnasal endoscope from the pha...

Chapter 44

Figure 44.1 Intragastric balloon.

Figure 44.2 Anchor attached to long polymer impermeable sleeve.

Figure 44.3 The delivery device of the sleeve.

Figure 44.4 The device introduced over the guidewire.

Figure 44.5 The releasing of the device.

Figure 44.6 The anchor attached to the duodenal mucosa.

Figure 44.7 Pseudopolyps at the site of anchor attachment.

Chapter 45

Figure 45.1 The full device components.

Figure 45.2 Treatment of a point bleeder – before (a) and two days afterward...

Figure 45.3 Hemostatic clips.

Figure 45.4 Full‐thickness resection.

Chapter 46

Figure 46.1 Trichobezoar.

Figure 46.2 Phytobezoar.

Figure 46.3 Trichobezoar endoscopic intervention usually consists of two ste...

Figure 46.4 The trichobezoar can be fragmented using various endoscopic devi...

Guide

Cover

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Practical Pediatric Gastrointestinal Endoscopy

Third Edition

Edited by

George Gershman

Professor of Pediatrics, David Geffen School of MedicineChief, Division of Pediatrics Gastroenterology, Hepatology and NutritionHarbor‐UCLA Medical CenterTorrance, California, USA

Mike Thomson

Professor of Paediatric Gastroenterology and Interventional EndoscopyDirector of the International Academy for Paediatric Endoscopy TrainingCentre for Paediatric Gastroenterology, Nutrition and HaepatologySheffield Children’s Hospital NHS Foundation TrustSheffield, UK;Portland Hospital for Women and ChildrenLondon, UK

This edition first published 2021© 2021 John Wiley & Sons Ltd

Edition historyBlackwell Publishing Ltd. (2e, 2011)

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Library of Congress Cataloging‐in‐Publication DataNames: Gershman, George, editor. | Thomson, Mike (Mike Andrew), editor.Title: Practical pediatric gastrointestinal endoscopy / edited by George Gershman, Mike Thomson.Description: Third edition. | Hoboken, NJ : Wiley‐Blackwell, 2021. | Includes bibliographical references and index.Identifiers: LCCN 2020022834 (print) | LCCN 2020022835 (ebook) | ISBN 9781119423454 (hardback) | ISBN 9781119423416 (adobe pdf) | ISBN 9781119423485 (epub)Subjects: MESH: Endoscopy, Gastrointestinal | Pediatrics–methods | Child | InfantClassification: LCC RJ446 (print) | LCC RJ446 (ebook) | NLM WI 190 | DDC 618.92/3307545–dc23LC record available at https://lccn.loc.gov/2020022834LC ebook record available at https://lccn.loc.gov/2020022835

Cover Design: WileyCover Image: © FatCamera/Getty Images

Personal statements

George GershmanTo the new generations of pediatric gastroenterologists and endoscopy enthusiasts: a letter to the future.

Once upon a time, there was a young fellow in Moscow, Russia, who was a resident working in one of the oldest hospitals in Moscow, named after Yevgeny Botkin, court physician to Tsar Nicholas II (who was murdered along with the entire Tsarust family by Bolsheviks in 1918).

The training was all about patient care. The diagnostic tools were limited to a stethoscope, basic laboratory support, and X‐rays. The time felt almost frozen.

One day, I heard a rumor that one of the attending physician named Eduard Rokhlin was performing unique procedures, and out of curiosity I asked for permission to watch.

To my surprise, I was allowed not only to observe the study but look inside the endoscope. I still remember that moment of excitement and disbelieve that I was looking inside the stomach of a live person in real time. It was the moment which changed my life. I was fortunate to witness the fast progression of flexible endoscopy from a primitive stage of large‐caliber fiberscopes with an eyepiece resembling that of old microscopes to modern high‐definition, slim and ultra‐slim video endoscopes, single‐ and double‐balloon enteroscopes, endoscopic capsules, and many other innovations which have opened unlimited diagnostic and therapeutic possibilities in the field of pediatric gastroenterology.

You, my young colleague, who have opened a new page of your life, step into a fascinating journey of new discoveries in pediatric gastroenterology.

I express my deep gratitude to Dr Eduard Rokhlin, who was my endoscopy mentor and dear friend; Professor Samy Cadranel and Jean‐François Mougenot: two remarkable physicians and endoscopists who opened the door for me to enter the world of European community of pediatric gastroenterology; Professor Jon A. Vanderhoof, who gave me the opportunity to share my endoscopy skills and scientific data with my American colleagues at the Annual Meeting of North American Society of Pediatric Gastroenterology and Hepatology in 1989; and Professor Marvin E. Ament, one of the pioneers of pediatric GI endoscopy, who invited me to work with him at UCLA in Los Angeles. Finally, this book would not be possible without love abd support of Irina, my amazing wife and healer and my daughter Zhenya, a talanted artist, educated and art historian and my grandauphter Nikka, a truly gifted musician and composer.

Mike ThomsonWhy Pediatric Endoscopy?

Please forgive this indulgence, but as you may divine from this, I am clearly a little too focussed, and some may say ‘sad and obsessed’, with this area of medicine!

Like most things in life, and particularly in the serendipitous, chaotic and mal‐designed world of medical careers, I ‘fell’ in to endoscopy in children. Which does sound a little ‘messy’!

I am very grateful to George my co‐Editor and massive contributor for the opportunity to join him in this venture ‐ we did it together for the Second Edition 10 years ago, and this version has massively surpassed that one. Marvin Ament should not be forgotten as an integral part of the first and second Editions ‐ a real progenitor of paediatric endoscopy. We hope that this Third Edition has kept pace with this fast‐changing field.

I was first exposed to endoscopy in children in 1986 in a large teaching hospital in the North of England where it was ‘hold them down, minimally sedate, and get on with it.’ Things have changed a bit since then! However, to be fair, at that point, I did not ‘get the bug’ for pediatric endoscopy. It was really still in its infancy, having been championed in the late 1970s and early 1980s by such giants of the field as Sami Cadranel (so sadly, recently left us), Marvin Ament and Jean‐Francois‐Mougenot. Sami, Jean‐Francois and I were (much) later get to know each other and become friends. They and many others set the scene for the undertaking of children’s endoscopy by children’s specialists in GI – a cause I have always believed in and tried to implement. Who wants an adult surgeon doing a quick sigmoidoscopy on your child with suspected Crohn’s and taking no biopsies? Never mind not getting to the ileum! Hobby horse time – I always call the lower GI procedure an ileo‐colonoscopy not simply a colonoscopy. Why, for instance, would you be happy with having a bronchoscopy where the bronchoscopist only examined the trachea and main left and right bronchi without going further? Or even just the left lung and not the right?!

My first inspirational moment came when I took up the position of GI/Hepatology Fellow in the Royal Brisbane Children’s Hospital in Australia in 1989 ‐ a perfect equation of work hard/play hard. My mentor Prof Ross Shepherd was, and is, one of the most astute clinicians I have had the good fortune to learn from ‐ and luckily he was a great teacher of endoscopy as well. Prof Geoff Cleghorn and Dr Mark Patrick deserve mention here as well and imparted knowledge and skill tips that I have not forgotten. Australia at this point were streets ahead of Europe in this area and in the 5 years I was there I had an accelerated endoscopy training, which, like many things in medicine, was down to good luck rather than good management. Also undertook my MD Doctorate on CF here.

Quick story ‐ on our research staff we had a vet called Ristan Greer and I had a patient who had recurrent H pylori type bug called then Gastrospirillum hominis (now Helicobacter heilmanii) only usually previously seen in cats and dogs – we agreed to scope the cats and dogs at their farm with Ristan anesthetising them and using an old scope that was to be thrown out we identified the micro‐organism in the cats, gave eradication to the girl and the cats simultaneously, and she was ‘cured’. Cue a paper in The Lancet.

Watersheds occur in life, and I chose, for family reasons, to return to the UK in 1994. Birmingham and Dame Professor Deirdre Kelly CBE and her world‐leading liver unit awaited. Gulp. Without doubt one of the most inspirational women and doctors in the UK, to this day. When I first arrived, I met Sue the amazing PA to Deirdre, and after she had shown me my office – in a Portacabin! – I asked her ‘Are you doing that accent for a joke?’ It took a while for me to get back in to her good books! It was easy transferring skills but not so easy adapting back to a West Midlands climate. I loved my time there but the only things that the two cities have in common is the letter ‘B’. No beach or surf in Brummie. Made some great life‐long friends there though. I clearly remember getting a phone call, possibly ‘tongue in cheek’, from the head histopathologist in Birmingham Children’s Hospital two weeks after I had started. I had performed a scope on a post‐transplant girl and sent the biopsies off. He said I had mislabelled the samples because I had put ‘terminal ileum’ on one, and they hadn’t seen that label for years, so was I sure! And so to another mentor, the extraordinary Deirdre Kelly, from whom I learnt many things ‐ but not much endoscopy. But another good friend which the journey of medicine has allowed me to make. She was instrumental in my application to then become a Consultant with the incomparable Prof John Walker‐Smith, one of the fathers of our discipline, at the Royal Free Hospital in London. Got lost, nearly missed the interview, swore I would never work and live in London ‐ got the job and moved to London.

The next ten years were eye‐opening. The ‘dream‐team’ of JAWS (which acronym I know he dislikes), Simon Murch, Alan Phillips, me and latterly Rob Heuschkel were as close to a medical family as is possible. We should remember here our friend Dave Casson who sadly passed away from gastric cancer. Importantly I was privileged to learn at John’s feet but almost, if not more, significant for me, I was able to hone my apprentice‐type ileo‐colonoscopy skills with the greatest of them all, Prof Christopher Williams. A unique character is a fair way to describe him, but he is acknowledged as having been the best of the best when it came to ileo‐colonoscopy training. Simon Murch, John Fell and I learnt a great deal. We were in the mid‐nineties, however, still iv drug users! Eric Hassall, the famous North American paediatric gastroenterologist and a good and wise friend, once wrote a paper ‘Why pediatric endoscopists should not be iv drug users.’ Referring to the dual role of performing a procedure and also administering the iv sedation. Holding down a child should never be part of an endoscopy, nor should respiratory rescue. ‘Let the anaesthetists do what they want to keep the child still, unknowing and amnesic and don’t get involved’ has always been my mantra. Cost and availability of anaesthetists is the only reason why it still happens in the bad old way.

So I had a vision ‐ please forgive me for sounding like a prima donna! The John Walker‐Smith Unit had been running a brilliant Paeds Gastro Course in December in London for at least 12 years. As the young guy and the endoscopy enthusiast I thought ‘why not add on a live endoscopy day?’ John was very receptive and the first one was a real experiment but it worked. I still owe Simon an apology for training the room camera on him as he was scoping and videoing his ‘gurnying’ (facial movements as if in pain), during a live ileo‐colonoscopy, to 150 people in the main auditorium! Fortunately, he has a great and forgiving sense of humour. It was probably the first ever successful live paediatric endoscopy meeting. The close interaction with scientists such as Alan Phillips also came out in this Course with biopsy orientation and handling adding another dimension. The Meeting seemed, apparently, to work smoothly ‐ but a bit like a swan gliding serenely over the lake’s surface, meanwhile its legs swimming frenetically beneath, we were frantically trying to get all the pieces of the jigsaw to fit together and at the appropriate time. It was amazing and a real privilege to be able to invite the great and good from the world of paediatric endoscopy over to London to teach over the next 10 years ‐ Victor Fox, Luigi Dall’Oglio, Jean‐Francois Mougenot, Jean‐Pierre Olives, Sami Cadranel, Yvan Vandenplas, Ernie Seidman, Harland Winter, Athos Bousvaros, Raoul Furlano and of course Eric Hassall. Other giants of the field I was to meet later.

Over the next ten years we worked closely with the adult GI Unit and Prof Owen Epstein and I produced a DVD with over 400 endoscopy videos and stills, which is still available and remains for me a great resource for Powerpoint presentations etc. This textbook has many other videos on the accompanying webpage if you are interested. The Paediatric Endoscopy Unit evolved and we started pioneering therapeutic techniques with close clinical governance, and always learning from meetings such as the BSG, ESGE, UEGW, and DDW which showcased new and exciting techniques in endo‐therapy. The Unit did however produce a non‐endoscopy virtue ‐ a wife and our first daughter ‐ Kay was a part of our team at middle grade level for a while which is how we met (Mills and Boon or not!) and I remain so grateful that she threw her towel in with me!

Eventually the ‘pull to the North’ became overwhelming for me ‐ back to where I grew up ‐ and in 2004 I took the difficult and painful decision to leave John, Alan, Simon and Rob and move to the relative peds GI virgin territory of Sheffield Children’s Hospital. Back to ‘God’s Own County’, Yorkshire. Thanks to Kay, my incredible and long‐suffering partner for agreeing and sacrificing her promising career in ‘Pharma’ to which she had made a transfer and a name for herself in a short time. I appreciate it more than you can know.

So, now a blank canvas ‐ almost. Prof Chris Taylor was the only paeds GI there when I arrived on, fittingly, April the 1st 2005. I remember that in the very first list I broke their only colonoscope! Oops! Time to get some more then. . . . . . .

Chris was a very generous host and indulged my ambitions. He was even kind enough as we became friends to ask me to be his best man and I was delighted ‐ only embarrassing him slightly.

In 2005 we carried on with the Royal Free Course but then transferred it to Sheffield the year after and converted it to a Hands‐On small group ileo‐colonoscopy Course over 2–3 days. This was to be the template for the nest 15 years and has increased in frequency driven by demand to about 6–8 a year.

Meanwhile we began to build the Unit and with my colleagues and friends we have now over 50 staff. Prof Chris Taylor and Prof Stuart Tanner (hepatology) retired (Chris only recently) and I was joined by consultant colleagues Sally Connolly (now also retired), David Campbell, Prithviraj Rao, Priya Narula, (temporarily Dalia Belsha, Franco Torrente and Camilla Salvestrini), Arun Urs, Natalia Nedelkopoulou, Shishu Sharma, Zuzana Londt, Intan Yeop and Akshay Kapoor. Amazing team who all bring something different to the table. The Gastro Nurses are so important to us led very ably by Valda Forbes. Dietitians also brilliant led by Lynn Hagin, SALT by Jane Shaw, and psychology by Charlotte Merriman are also hugely important and fantastic. Prof Marta Cohen, head of histopathology and I have collaborated on research over the years and she is always energetic and a great colleague to have.

The people of Sheffield and the region are, contrary to popular belief of a Yorkshireman being a ‘Scotsman robbed of his generosity’, incredibly generous. The Sheffield Children’s Hospital Charity (led by my friend David Vernon‐Edwards) were, and have been, pivotal in financial help to make the Unit the most fantastic place to work ‐ the Endoscopy Unit of the Future, the double balloon enteroscopy set up, the wireless capsule endoscopy service and the new magnetic‐controlled capsule technology, and most recently the Symbionix virtual endoscopy training simulator, are amongst a few of the things that they have kindly and generously funded for us, allowing us to stay at the cutting edge of training and diagnostic and endo‐therapeutic capability.

An area that I am particularly happy with is the ESPGHAN Council’s open‐minded approach to the Endoscopy Special Interest Group initiatives in terms of Training. Hands‐On Courses are spreading, the Endoscopy Learning Zone at the Annual Meeting has been fantastic and is going from strength to strength under the guidance now of Prof Raoul Furlano, and the first ever live endoscopy session occurred in 2019 in Glasgow at the Annual ESPGHAN Meeting and was very well received. There is nothing like performing live endoscopy to 500 people to get the cardiovascular system energised! Thank you to the recent Presidents of ESPGHAN Raanan Shamir and the ever‐enthusiastic Sanja Kolacek. Sanja has pushed for, and obtained funding for, the ESPGHAN Pediatric Endoscopy Fellowships which are starting in early 2021, which will be amazing ‐ thank you!

My endoscopic ‘raison d’être’ is to attempt to put the paediatric surgeons out of work! Hence pushing the boundaries in such areas as are covered in this Textbook. Nevertheless, I think it is critical that we work hand in hand with our surgical colleagues, many of who perform endoscopy, in order to blur the interface between our approaches. I am extremely fortunate to work with some fantastic and enlightened individuals in the surgical team and we are almost a joint Unit nowadays – as can be seen by our innovations with laparoscopic assisted endoscopic percutaneous jejunostomy and duodenal web division, amongst many others. Maybe I am a frustrated surgeon after all! Hopefully the web page is educational to those that access it with many videos etc. I am particularly indebted to the open‐minded attitude and team‐spirited nature of Mr Sean Marven, Mr Richard Lindley, Prof Ross Fisher, Mr Suresh Murthi, Prof Prasad Godbole, Ms Emma Parkinson, and more recently Ms Liz Gavens and Ms Caroline McDonald. Sparring with Jenny Walker was always fun and we are now good friends. Rang Shawis and Julian Roberts should not be missed out here.

Endoscopy in the modern world in children could not occur ‐ especially endo‐therapeutic ‐ without the excellence of our anaesthetists ‐ my stars are Dr David Turnbull, Dr Liz Allison, Dr Kate Wilson, Dr Rob Hearn, Dr George Colley at the Royal Free, and most importantly of all, the best paediatric anesthetist of them all, Dr Adrian Lloyd‐Thomas (AL‐T). A quick story ‐ the modern practice of topical application of Mitomycin C after esophageal dilation came from a chance conversation with AL‐T, who told me that the ENT guys used Mitomycin C post‐laryngeal reconstruction to prevent circumferential stenosis ‐ we tried it and it worked in the esophagus of a girl requiring multiple frequent esophageal dilation. Cue a paper in The Lancet. Perhaps we should have more cross‐specialty conversations?

We should remember that this is the only truly ‘procedure‐specific’ paediatric specialty and stick to our guns with respect of the importance of endoscopy in our training. The Guidelines and Position Papers, some joint with ESGE and NASPGHN have been extremely well received and, in addition, have helped in raising the JPGN Impact Factor to its new dizzying height of nearly 3.

Medicine is a vocation amongst us of course, and training the next generation has been one of my major aims. In this I am particularly grateful to Prof Sanja Kolacek in her unswerving support and application of her considerable energy in moving forward the recent amazing ESPGHAN Endoscopy Fellowship Program ‐ worth mentioning again!

We should, in my view, never compromise on the quality of training or care delivery afforded by paediatric endoscopy by those of us fortunate enough to have benefitted by it in our careers. Adult GI endoscopists should be involved only if we cannot avoid it ‐ that comes down to our learning the correct skills and techniques and making their involvement redundant. We still have plenty to learn from them though, I will acknowledge.

Recently we have created a global community for Pediatric Endoscopy ‐ adult GI, European, North American, South American, Asian, Australasian Peds GI ‐ and Joint Endoscopy Guidelines have emerged – this is fantastic and I am sure that this fruitful collaboration will continue. Special mention should go to the drivers of these collaborative efforts and the contributors ‐ Catharine Walsh, Doug Fishman, Jenifer Lightdale, Jorge Amil‐Dias, Andrea Tringali, Mario Vieira, Raoul Furlano, Victor Fox, Looi Ee, Patrick Bontems, Matjaz Homan, Rok Orel, Frederick Gottrand, Alexandra Papadopoulou, Salvatore Oliva, Erasmo Miele, Claudio Romano, Luigi Dall’Oglio, Rob Kramer, Mike Manfredi, Diana Lerner, Marsha Kay, Tom Attard, Warren Hyer, Joel Freidlander, ‘The Richards’ Hansen and