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دكتور أشرف 01-21-2012 11:48 AM

Practical Pediatric Gastrointestinal Endoscopy
 
السلام عليكم و رحمة الله و بركاته
الحمد لله رب العالمين، والصلاة والسلام على المبعوث رحمة للعالمين نبينا محمد وعلى آله وصحبه أجمعين



Practical Pediatric Gastrointestinal Endoscopy

In the late 1960s and early 1970s, sporadic attempts to perform esophagogastroduodenoscopy (EGD) using fiberscopes designed for adults were made in children. However, the actual
“birth’’ of pediatric EGD occurred a few years later when prototypes of pediatric flexible gastroscopes and panendoscopes became commercially available. Subsequently, the pediatric community received unequivocal evidence of very low rates of complications related to upper gastrointestinal (GI) endoscopy, high diagnostic yields, cost-effectiveness due to safe use of the
procedure in outpatient settings, and the ability to perform a variety of therapeutic procedures successfully adopted from adult GI practice. This led to widespread use of EGD in pediatrics.
Flexible GI endoscopy is a unique method of investigation of the GI tract in real time. It links direct observation of the object,
with or without magnification and application of different dyes, with target biopsy, ultrasound technique, and variety of therapeutic procedures. It is an invasive procedure by definition.
Whenapplied to pediatric patients, safety becomes a major priority.
In order to minimize morbidity associated with pediatric GI endoscopy, the endoscopist, especially the beginner, should learn all technical aspects of the procedure including the following:
 Endoscopic equipment such as endoscopes, light sources,
biopsy forceps, snares, graspers, needles, electrosurgical devices,
and all other accessories.
Appropriate setting of the endoscopic equipment and doses
of commonly used medications and solutions such as
epinephrine, glucagon, and sclerosing agents.
Proper techniques of diagnostic and therapeutic procedures.
The endoscopist should also become familiar with age-related
anatomic variations of the GI tract and specific responses of the
central nervous system, respiratory, and cardiovascular systems
to artificial conditions created by the procedure itself. These include
intubations of the esophagus, increased intra-abdominal
pressure, elevation of the diaphragm, and stretching of the
mesentery.

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