Enfrentamiento de la ingesta de cuerpo extraño en un Hospital Regional del sur de Chile / Management of foreign body ingestion at a Regional Hospital in southern Chile

Introducción: La ingesta de cuerpos extraños (ICE) es frecuente en pediatría y puede llevar a complicaciones. Nuestro objetivo es revisar la experiencia de nuestro centro en el manejo de estos pacientes y proponer un protocolo de tratamiento. Material y Método: Estudio transversal retrospectivo, observacional y descriptivo, en el cual se revisaron los informes endoscópicos y fichas de pacientes con diagnóstico de ICE manejados por la Unidad de Endoscopia Pediátrica del Hospital Clínico Regional de Concepción entre enero de 2013 y junio de 2017 (53 meses), totalizando 40 casos. El registro y análisis de los datos se realizó con Microsoft® Excel 2016® para MacOS®. Resultados: El promedio de edad fue de 3,96 ± 3,24 años. La moda estadística fue de 2 años. A todos los pacientes se les realizó una endoscopia digestiva alta. El CE más frecuente fue la moneda (61,9%). En 6 casos (14,2%) fue una pila de botón. La retención de CE fue en tercio proximal del esófago (30,9%), el cuerpo gástrico (26,2%) y el tercio distal del esófago (14,2%), extrayéndose principalmente con pinza de cuerpo extraño (90,4%). El 57,5% evidenció alguna lesión relacionada a la ubicación del CE, siendo la más grave la producida por pila de botón. Conclusión: La ICE en niños es una entidad potencialmente peligrosa, por lo que se hace necesario disponer de una unidad de endoscopia pediátrica y protocolos de manejo para evitar complicaciones, sobre todo con objetos de alto riesgo.

Introduction: Foreign body ingestion (FBI) is common in pediatrics and can lead to complications. The aim of the present study is to review the experience of our center in the management of these patients and to propose a treatment protocol. Material and Method: Retrospective, observational and descriptive cross-sectional study, in which the endoscopic reports and records of patients diagnosed with IFB managed by the Pediatric Endoscopy Unit of the Regional Clinical Hospital of Concepción between January 2013 and June 2017 (53 months) were reviewed, with a total of 40 cases. Data recording and analysis was performed with Microsoft® Excel 2016® for MacOS®. Results: The average age was 3,96 ± 3,24 years. The statistical fashion was 2 years. All patients underwent a upper gastrointestinal endoscopy. The most frequent FB was the coin (61,9%). In 6 opportunities (14,2%) was a button batery. FB retention was in the proximal third of the esophagus (30,9%), the gastric body (26,2%) and the distal third of the esophagus (14,2%), being extracted mainly with foreign body clamp (90,4%). The 57,5% showed some injury related to the location of the FB, being the most serious the produced by button batery. Conclusion: FBI in children is a potentially dangerous entity, so it becomes necessary to have a pediatric endoscopy unit and treatment protocols to avoid complications, especially with high-risk objects.

Massive Gastric Ulcer Bleeding in a Healthy Full Term Infant / 대한소화기학회지

Gastric ulcer bleeding in neonatal period, mainly in preterm newborn babies or in neonates treated in intensive care units, is relatively frequent, However the occurrence of significant gastric ulcer bleeding in healthy full term infants is unusual. We experienced a case of massive upper gastrointestinal (GI) bleeding in a 3-day-old healthy full term infant. Endoscopic examination confirmed the presence of gastric ulcerations. Treatment was initiated with transfusion and histamine 2 receptor antagonist, and the clinical signs resolved. Mother's serum antibody to Helicobacter pylori (H. pylori) was positive. We collected stool of the patient including other 17 infants in the intensive care unit. A highly sensitive semi-nested PCR for H. pylori DNA was performed, but all infants including the patient revealed negative. H. pylori infection is not related with upper GI bleeding in healthy full term infants. In conclusion, the diagnosis of upper GI bleeding in infant can be easily made by means of pediatric endoscopy, which is a simple and a well tolerated examination.

The Clinical Usefulness of Esophagogastreduodenoscopy in Neonates and Infants / 대한소화기내시경학회지

BACKGROUND/AIMS: Endoscopic examination of upper gastrointestinal tract disease in infancy and childhood was introduced 2 decades ago. However, clinical indication, premedication, endoscopic features, and practical problems have been infrequently reported in neonate and infants, Therefore, the usef'ulness and problems of endoscopy in these pediatric patients was evaluated. METHODS: Twelve pediatric patients who underwent endos-copic examination which involved a choledochoscope, bronchoscope, and gastrofibroscope included 8 neonates and 4 infants who suffered from gastrointestinal symptoms. Drugs for premedication were chloral hydrate, diazepam, midazolam and ketamine in single or combined administration. RESULTS: Clinical manifestations were hematemesis (67%), melena (42%), vomiting (8%), weight loss (8%), fever (8%) and irritability (8%). Indica-tions for endoscopic examination were upper gastrointestinal Weeding (67%), upper gastrointestinal obstruction (8%), acute drug intoxication (8%), foreign bodies in the stomach (8%) and evaluation for varix (8%). Endo-scopic findings revealed a gastric ulcer (48%), acute gastric mucosal lesion (8/<), external compression on the duodenum (8%), a gastric foreign body (8%), acute esophago-gastritis (8%) and esophageal and gastric varix (8%). Therapeutic endoscopy was performed in 2 patients, One case of hypoxia occurred during diagnostic endoscopy. CONCLUSIONS: Endoseopic examination of the upper gastrointestinal tract is a useful and safe proce-dure to detect diseases in neonates and infants if it is done by experienced endocopists and in the circumstances of adequate premedication.