Endoscopic management of esophageal mucosal bridges in children with esophageal atresia

BACKGROUND AND STUDY AIMS

Esophageal mucosal bridge (EMB) may be diagnosed at the anastomotic site in children operated on for esophageal atresia (EA) but so far only a few cases (n = 4) have been reported. This study aimed to characterize EMB in children with EA, risk factors, and treatment.

PATIENTS AND METHODS

This retrospective multicenter study recorded patient's characteristics, EMB diagnosis circumstances, endoscopic management, follow-up, and EMB recurrence in children with EA aged less than 18 years, compared with paired EA patients without EMB.

RESULTS

Thirty patients were included (60% male, 90% EA/tracheoesophageal fistula, 43% associated malformations). Compared to 44 paired controls, EMB was associated with a history of nasogastric tube feeding (31% vs. 9.1%, p = 0.02) and severe gastroesophageal reflux disease (history of fundoplication: 41.4% vs. 13.6%, p < 0.01). 77% had symptoms (food impaction and/or dysphagia). Endoscopic management was performed in 53% of patients (83% electrocoagulation) with no technical difficulties or complications. 80% of the symptomatic patients with EMB improved after endoscopic treatment, independently of anastomotic stricture dilatation or not.

CONCLUSION

EMB endoscopic management by electrocoagulation is safe and often leads to symptom improvement.

Artificial Intelligence in Pediatric Endoscopy: Current Status and Future Applications

The application of artificial intelligence (AI) has great promise for improving pediatric endoscopy. The majority of preclinical studies have been undertaken in adults, with the greatest progress being made in the context of colorectal cancer screening and surveillance. This development has only been possible with advances in deep learning, like the convolutional neural network model, which has enabled real-time detection of pathology. Comparatively, the majority of deep learning systems developed in inflammatory bowel disease have focused on predicting disease severity and were developed using still images rather than videos. The application of AI to pediatric endoscopy is in its infancy, thus providing an opportunity to develop clinically meaningful and fair systems that do not perpetuate societal biases. In this review, we provide an overview of AI, summarize the advances of AI in endoscopy, and describe its potential application to pediatric endoscopic practice and education.

Interfaces in Pediatric Gastrointestinal Endoscopy: Who Should Do It?

BACKGROUND

Gastrointestinal endoscopy is one of the most frequently performed diagnostic and therapeutic procedures in children nowadays.

METHODS

Since the size of endoscopes has been adapted to pediatric patients, endoscopic procedures are performed almost routinely in pediatric gastrointestinal patients. However, this is an invasive procedure done under deep sedation, and procedure-related or sedation-related complications can occur more easily in pediatric patients. The endoscopist must consider various aspects (e.g., indications and contraindications for endoscopy, monitoring during and after the procedure) to ensure the procedure is performed successfully and safely.

RESULTS

In our opinion, pediatric endoscopy should be carried out by pediatric endoscopists at specialized pediatric clinics. In Germany, there are regulatory demands dictating that in order to become a pediatric gastroenterologist, further education is necessary. Experienced centers which offer this education including training programs for pediatric endoscopy can be found on www.gpge.de.

CONCLUSION

Provided these preconditions are adhered to, gastrointestinal endoscopy is a safe and efficient technique with minimal complications even in children and infants.

Appropriateness, endoscopic findings and contributive yield of pediatric gastrointestinal endoscopy

AIM

To determine the predictability of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) and American Society for Gastrointestinal Endoscopy (ASGE) guideline with regard to appropriate endoscopic practice in children, positive endoscopic findings and contributive yield in clinical practice.

METHODS

This was a descriptive, retrospective analysis, conducted at the Department of Paediatrics, University Malaya Medical Centre, Malaysia. All children who had esophagogastroduodenoscopy (EGD) and colonoscopy from January 2008 to June 2011 were included. An endoscopy was considered appropriate when its indication complied with the NASPGHAN and ASGE guideline. All endoscopic findings were classified as either positive (presence of any endoscopic or histologic abnormality) or negative (no or minor abnormality, normal histology); effecting a positive contributive (a change in therapeutic decisions or prognostic consequences) or non-contributive yield (no therapeutic or prognostic consequences).

RESULTS

Overall, 76% of the 345 procedures (231 EGD alone, 26 colonoscopy alone, 44 combined EGD and colonoscopy) performed in 301 children (median age 7.0 years, range 3 months to 18 years) had a positive endoscopic finding. Based on the NASPGHAN and ASGE guideline, 99.7% of the procedures performed were considered as appropriate. The only inappropriate procedure (0.3%) was in a child who had EGD for assessment of the healing of gastric ulcer following therapy in the absence of any symptoms. The overall positive contributive yield for a change in diagnosis and/or management was 44%. The presence of a positive endoscopic finding was more likely to effect a change in the therapeutic plan than an alteration of the initial diagnosis. A total of 20 (5.8%) adverse events were noted, most were minor and none was fatal.

CONCLUSION

The NASPGHAN and ASGE guideline is more likely to predict a positive endoscopic finding but is less sensitive to effect a change in the initial clinical diagnosis or the subsequent therapeutic plan.