THE FASCINATING WORLD OF PAEDIATRIC ENDOSCOPY

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
  • Sword swallower - 1870 - Technique
  • Ikeda - 1970 - Pediatric endoscopy

Principles of Endoscopy: 100years
  • Hopkin - Rod Lens Optical system
  • Fibreoptic - 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->SuspiciousFB

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 Hypertensio

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 - 1Diagnostic:
  • 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
  • Psychological Disturbance
Colonoscopy
a) More difficult than Gastroscopy
b) Easier in children -> adults
c) Barium Enema Still best
d) Expensive / Infrequent Utility
e) Depend on Audit Gastroenterologist
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 - Resectability / Biopsy / L. Node

Indications - 2
Therapeutic:
  • Appendicectomy
  • Cholecystectomy
  • Meckel's diverticulum
  • Adhesiolysis
  • Cryptorchidism
  • Ovarian Cyst
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