Pediatric Gastrointestinal Endoscopy

• The symptoms or indications of pediatric gastrointestinal disorders are pain while swallowing, difficulty swallowing, chronic vomiting, chronic abdominal pain, chronic diarrhea, paleness, and unexplained weight loss.
• A capsule endoscopy is a diagnostic option that does not require oral or rectal insertion. However, the main contraindication for this procedure is a suspected intestinal obstruction, as capsules may get stuck in the intestine (capsule retention).

 
Gastrointestinal endoscopy is a method used in the diagnosis and treatment of gastrointestinal diseases, whereby a tiny camera on a long, flexible tube is passed through the mouth or via the rectum to examine the internal parts of the body. An upper GI (gastrointestinal) endoscopy is used to examine the esophagus, stomach, and duodenum (the first part of the small intestine) and takes approximately 20-30 minutes. A lower GI endoscopy examines the ileum (the last and longest section of the small intestine), colon, and rectum, and takes about 30-60 minutes to complete. Additionally, capsule endoscopy can be used to diagnose issues in the jejunum (the middle section of the small intestine), and the examination usually takes about 8-12 hours.

Symptoms or indications in children that require diagnosis by an upper GI endoscopy:

1. Pain while swallowing, difficulty swallowing, or blockages to swallowing
2. Swallowing of toxic substances, acids or chemicals, or foreign objects
3. Chronic vomiting
4. Bleeding in the upper GI tract
5. Chronic abdominal pain and other warning signs of suspected illness or disease
6. Chronic diarrhea or impaired digestion and absorption for unknown reasons
7. Loss of protein into the intestines (protein-losing enteropathy)
8. Chronic paleness or unexplained weight loss
9. Family history of stomach cancer or polyposis syndrome

Symptoms or indications in children that require diagnosis by a lower GI endoscopy:

1. Bleeding in the lower GI tract
2. Chronic abdominal pain and other warning signs of suspected illness or disease
3. Chronic diarrhea
4. Loss of protein into the intestines (protein-losing enteropathy)
5. Suspected inflammatory bowel disease of unknown causes
6. Chronic paleness or unexplained weight loss
7. Suspected intestinal polyps; family history of stomach cancer or polyposis syndrome
    

1. Remove foreign objects from the digestive tract
2. Stop bleeding in the gastrointestinal tract using the endoscopy to inject substances at the bleeding point, apply heat or electric shock to stop the bleeding, tie off bleeding esophageal varices, use a clip or spray to stop bleeding, etc.
3. Insert a feeding tube into the abdomen
4. Provide endoscopic suturing of esophageal leaks or perforations
5. Remove polyps in the gastrointestinal tract
6. Dilate a narrowed digestive tract

1. Children with respiratory or cardiovascular issues whose conditions or symptoms are not stable (an endoscopy can be performed, however, if the condition is stable or if the child has previously had the disease and been cured)*
2. Children with intestinal perforations or peritonitis*
3. Children who did not follow proper dietary protocols and refrain from eating at the appropriate times prior to the procedure*
4. Pediatric patients with severely low platelet count or clotting disorders (however this group of patients should receive a blood component transfusion prior to the endoscopy)
5. Pediatric patients who have recently undergone gastrointestinal surgery
6. Those with mild respiratory infections

 * Some pediatric patients with these contraindications may be considered for endoscopy

Preparing for an endoscopy

1. Abstain from anticoagulant medications such as aspirin, enoxaparin, etc.
2. Abstain from antacids and antibiotics (only necessary in cases of preparation to test for helicobacter pylori bacteria; not necessary in other cases)  
3. In the case of a lower GI endoscopy, the doctor will recommend a fiber-free diet for 2-3 days prior to the endoscopy, as well as laxatives to prepare the colon 1 day prior to the endoscopy. For older children, colon preparation laxatives can be taken at home; for younger children, however, the doctor may require a hospital stay of one day for this purpose.

On the day of the GI endoscopy

1. Children younger than 6 months should abstain from food for 4-6 hours; children 6 months old and above should abstain from food for 6-8 hours
2. The child will be given a light, general anesthetic to help them sleep during the endoscopy and may also receive a local anesthesia injection in the throat area in the case of an upper GI endoscopy
3. Antibiotics may be given prior to an endoscopy only if there is a risk of infection (generally speaking, GI endoscopy has a low risk of infection so antibiotics may not be required prior to the procedure)
4. After the endoscopy has been completed, the child’s symptoms will be observed in the recovery room for 1-2 hours. Once the child is fully awake, they can begin to sip water and liquids. If the doctor confirms there are no contraindications for eating, and the child doesn’t experience any problems swallowing, they can start eating as well.

1. There may be some mild abdominal pain and/or bloating after the endoscopy because of air blown into the stomach during the procedure. These symptoms will disappear on their own, but a carminative may be taken if symptoms are severe.
2. There may be soreness and irritation in the throat after an upper GI endoscopy
3. The child may eat and exercise normally if there are no contraindications or prohibitions from the doctor due to other illnesses.
4. In the case of a GI biopsy, there may be some slight bleeding in stools

1. Excessive rectal bleeding
2. Severe abdominal pain
3. Excessive vomiting
4. Fever

Capsule endoscopy is an option that does not require oral or rectal insertion to make a GI diagnosis.

• Some children may be afraid of the endoscopic procedure and not allow it to be carried out. A capsule endoscopy is an alternative for children who are able to swallow a capsule of a size of about 1.1 x 2.5 cm. This method is mostly used for children aged more than 4-5 years as they are more capable of swallowing the capsule. After the capsule is swallowed, it moves through the digestive tract until it is excreted in the child’s stool. 
• This option is used to diagnose lesions in the jejunum (middle section of the small intestine) or unexplained pallor (paleness)
• One limitation of capsule endoscopy is that it cannot be used to perform a biopsy for examination or treatment; as such, once a lesion is found, endoscopic examination of the small intestine must be carried out again at a later date for biopsy or treatment
• Preparation for this procedure is the same as that recommended for a GI endoscopy

Note: The main contraindication for the use of a capsule endoscopy is a suspected intestinal obstruction, as capsules may get stuck in the intestine (capsule retention).