Guideline
Modifications in endoscopic practice for pediatric patients

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Indications and contraindications

The indications for upper endoscopy in the pediatric age group are similar to those for adult endoscopy2, 3 and are summarized in Table 2. The endoscopist must be aware of the fact that all infants, many children, and some adolescents cannot verbalize or describe symptoms accurately. Occult signs and symptoms that may prompt an endoscopy in infants and children include failure to thrive, limitation of usual activities, unexplained irritability, and anorexia.

Two other circumstances that occur

Preprocedure preparation

Preparation for endoscopy in pediatric patients requires attention to physiologic issues, as well as emotional and psychosocial aspects of both the patient and the parent or guardian. Some of the anxiety engendered by endoscopy stems from preprocedure elements of intravenous (IV) line placement17 and separation from parents. A preprocedure health evaluation, including a health history, American Society of Anesthesiologists (ASA) score, medication history, allergy assessment, age, weight, and

Sedation, analgesia, and monitoring

Most GI endoscopy is performed by using moderate sedation54 or general anesthesia. Moderate sedation refers to a controlled state of diminished consciousness wherein protective reflexes, the ability to respond to moderate physical or verbal stimuli, and the ability to maintain a patent airway are retained. In contrast, deep sedation refers to a controlled state of depressed consciousness from which the patient is not easily aroused, with likely loss of protective airway reflexes and of the

Postprocedure monitoring and discharge

After completion of endoscopic procedures, children should be monitored for adverse effects of the endoscopy or sedation. Vital signs and oxygen saturation should be monitored at specific intervals. The American Academy of Pediatrics has established recommended discharge criteria after sedation.36 The patient should be easily aroused, and protective reflexes should be intact. Speech and ambulation appropriate for age should return to presedation levels. Patients who received reversal agents

Equipment

Resuscitative equipment should mirror that available for adult conscious sedation, with attention to the availability of devices of appropriate size and drug doses for all sizes and ages being treated. Necessary supplies include pediatric-caliber IV tubing, arm boards, IV needles, face masks, oral and nasal airways, laryngoscopes, suction catheters, endotracheal tubes, and nasogastric tubes. An emergency or code cart stocked for representative age groups should be readily available.

Diameters of

Summary

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    Endoscopic procedures including ERCP, EUS, WCE, and DBE in the pediatric population are both safe and effective. (1C+)

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    Endoscopy in children should be performed by pediatric-trained gastroenterologists whenever possible. (3)

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    Adult-trained endoscopists are often needed to provide advanced endoscopic services, such as EUS and ERCP, or basic endoscopy services in the absence of pediatric-trained endoscopists, and should coordinate their services with pediatricians and pediatric specialists. (3)

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    This document is a product of the ASGE Standards of Practice Committee. This document was reviewed and approved by the governing board of the ASGE.

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    Copyright © 2008 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.