The Fascinating World Of Pediatric Endoscopy

ISSN 0973 - 0958

FASCINATING WORLD OF PAEDIATRIC ENDOSCOPY

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THE FASCINATING WORLD OF PAEDIATRIC ENDOSCOPY

CG PEDICON 2006, 7-8TH OCT 2006, RAJNANDGAON, CHATTISGARH

Dr. Manohar Tule,
M.S.;M.Ch.;Dip.P.U(U.K.);F.A.C.S.:
F.I.S.;F.A.I.S,;M.B.
Director, N.D.Memorial Institute of Paediatric Endoscopy
Nagpur (M.S.)

Introduction :-

300 Children die every year -(due to Foreign body in Respiratory Tract)
Oldest Endoscopy is Bronchoscopy
Bozzini - 1806 - Mirror with Candle
Kussumal- 1860- Oesophagoscope
Swoard swallower - 1870- Technique
Ikeda - 1970- Pediatric endoscopy

Principles of Endoscopy - 100years

Hopkin - Rod Lens Optical system
Fiberoptic - Glass fibers- T / Reflection
- Coherent - Image
- No coherent - Light
Microchip & Xenon Light processor

Bronchoscopy:

Procedure -

Never as outdoor procedure
In operation theater
Backup of intensive care facility
No pre-endoscopy sedation
Discontinue - Repeat- No Longtime

Types -

Rigid - 2.5 mm - 6 mm/23 to 30 cm Good ventilation - Narrow Passage Better exposure / Adequate time Better manipulation - Different
Flexible	-	Therapeutic
	-	Can admit	-	Endotracheal tube
			-	Rigid bronchoscope
	-	Upper lobe	-	Lavage
Negative RB	- >	Indication	- >	FB -> Suspicious FB

Indications -Plenty

FB
Strider
Bleeding
H-type TOF
Asthma / Cough - M. Plugs
Stenosis leaser treatment
Primary TB
Cough - 3 months
Atelectasis / - Pneumonia
Bronchial lavage - Pressure -NaCI+ Salbutamol

Relative Contraindications :-

Bleeding Diathesis
Hemodynamic Instability
Arrhythmias
Hypoxemia
Pulmonary Hypertension

Effect of Foreign Body - 1

Immediate - RDS. - Forgotten
Moveable F.B.- Irritate -S/S
Late changes - Entirely Forgotten
Chronic Foreign Body Syndrome
Drowned Lung / Lung Abscess/
Stricture/ Bronchiectasis

Effect of Foreign Body - 2

Allergic Bronchitis Mechanical -
Check Valve - Atelectasis
Stop valve- Emphysema / perforation
Pathological Changes -
Vegetable bronchitis

Symptoms of Foreign Body -1

Sudden RDS / Chocking / Gaggling
Wheezing
Paroxysmal cough / Hemoptysis
Aphonia
Refractory Bro - Asthma

Symptoms of Foreign Body - 2

Recurrent of Persistent pneumonia in single lobe
Asymptomatic - Forgotten Initial
Negative Radiology - 10%
Site related - Trachea - Audible Sap / Palpable thud
X-ray - Emphysema / Collapse / Consolidation
Fluoroscopy - Exp./ Inspiration Film

Complications -

Prolonged sleep - Hypoventilation
Edema - Glottis / Sub-glottis
Perforation - Pneumo - Thorax / Mediastinum
Bleeding
Infection

Post Bronchoscopy

Oxygenation
X-ray chest - Complete Recovery
Pneumothorax
No Residual FB

Peculiarities of PRT (Paediatric Respiratory Tract)

Bronchi	-	Few alveoli
No Atelectasis	-	Faster Air Flow System
	-	Strong Diaphragm
	-	Anti-atelectatic Factor - Surfactant
Mucociliary Clearance	-	Faster - Short passage
Small vascular Bed	-	Alveolar surface

Oesophago - Gastro - Intestinal Endoscopy-

Introduction -

Only radiological
Ekeda 1970 - Paed. Endoscopy
Gastroscope - 50-75 cm small Bowel
Colonoscope - 10-20 cm terminal ileum
Hischowitz 1958- First Fiberglass scope
5.8mm/8mm Video- Endoscopy With Chip Camera

Oesophagoscopy

Rigid / Flexible Fibrescope
Sclerotherapy possible - Both
Gastric Varices - Fibrescope Only
Tamponade Effect - Rigid Endoscope
Banding -Fibrescope
Done Under G.A

Indications - 1
Diagnostic-

Dysphagia - Mechanical / Neuronal / Neurogenic
TOF - H- type
GEReflux
Upper Abdominal Pain
Corrosive Injury
Upper G. I. Bleeding

Indications - 2
Therapeutic -

Dilation
Foreign Body removal
Sclerotherapy / banding
Electro coagulation - 3F Ureteric Cath
Intraluminal Laser Therapy

Complications -

Overinflation
Perforation -Inexperienced Endoscopist
Massive Hemorrhage
Psychogical Disturbance

Colonoscopy :

Paediatric laparoscopy:

Introduction -

All Non - Invasive modalities exhausted
Not Substitute modalities exhausted
Systematic tour of Abdomen
Finding Pathology - should not stop

Indications - 1
Diagnostic-

Acute / Chronic AP
Liver Biliary Pathology
Trauma
Chylous Ascitis - Leak
Intersex
Cryptorchidism
Oncology - Resectility / Biopsy / L. Node

Indications - 2
Therapeutic -

Appendicectomy
Cholecystectomy
Meckel's Diverticulum
Adhesiolysis
Cryptorchidism
Ovarian Cyst

Last Updated on 15-03-2007

How to cite this url

CG Pedicon 2006 - Conference Abstracts.Pediatric Oncall [serial online] 2007 [cited 15 March 2007(Supplement 3)];4. Available from:
http://www.pediatriconcall.com/fordoctor/Conference_abstracts/
cgpedicon2006/Fascin.asp

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