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Pediatric Endoscopy Christopher D. Jolley, MD Pediatric Gastroenterology, University of Florida

Pediatric Endoscopy Christopher D. Jolley, MD Pediatric Gastroenterology, University of Florida. Outline. Equipment Accessories. Endoscopy. Fiberoptic endoscopy 1961=flexible, “one eye at a time at the ocular”

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Pediatric Endoscopy Christopher D. Jolley, MD Pediatric Gastroenterology, University of Florida

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  1. Pediatric EndoscopyChristopher D. Jolley, MDPediatric Gastroenterology, University of Florida

  2. Outline • Equipment • Accessories

  3. Endoscopy • Fiberoptic endoscopy 1961=flexible, “one eye at a time at the ocular” • Video endoscopy- miniature CCD (charge-coupled devices) –mid 1980s, fiber optics provide the light, CCD digitizes and transmits to processor

  4. Upper Endoscopy • Rate of complications 0.11% Shamir M Schuman BM Gastrointest Endosc 1980;26:86-91 • Most common is respiratory depression • Most serious is perforation (0.03%)-site is usually the piriform fossa

  5. Enteroscopy • Thread-guided method-thread/teflon tube/scope (no longer available) • Push –most commonly used, +/- overtube • Sonde-piggy-back • Intraoperative • Wireless capsule

  6. Colonoscopy • Complications-usually related to therapy • Hemorrhage -1-2% of polypectomy, 2 weeks • Perforation –less frequent (0.5-1% of polypectomy) • Polypectomy syndrome- pain, fever, leukocytosis due to peritonitis from full thickness burn • Pneumatic perforation-R colon, remove air on withdrawal

  7. Gastroscope-GIF 160 • ED 8.6 mm (accomodates bander 8.6-11.5 mm) • Channel 2.8 mm – standard size • Bx/snare-2.8 mm, Roth net 2.5 • Injector/heater probe 2.3 mm

  8. GIF- N180 • ED 4.9, channel 2 mm • Trans-nasal, without sedation

  9. Colonoscopes • Peds colonoscope • Same length as adult • 11.3 mm/3.2 mm • Newer adult scope is 12.8/3.7-older adult scopes have larger diameters

  10. Hemostasis • Non-variceal Injection-epi (1:10000), sclerosants, fibrin sealant Contact thermal device-heater probe Noncontact: Nd:YAG, APC Clips

  11. Thermal Devices-Contact • Heater probe, multipolar probe • More effective at coagulating medium-sized arteries • Coaptive coagulation= tamponade+coagulation and wash

  12. Contact Thermal Devices • Bipolar coagulation (BICAP or gold probe) 10-20 W, 2-10 s (adult) • Heater probe 10-30 J, 2-4 pulses

  13. Polypectomy bleeding

  14. Thermal Devices-noncontact • Nd:YAG laser • Argon plasma coagulation

  15. Variceal hemorrhage • Injection sclerotherapy- risk of complication outweigh its use for primary prophylaxis • Bleeding, ulceration, bacteremia, pleural effusion, perforation • Banding-preferable to injection particularly in prophylaxis • Cyanoacrylate glue-gastric varices

  16. Varicealbanding

  17. http://www.cori.org/index.asp http://www.cori.org/research_images.asp

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