ABSTRACT
Infants and children undergoing upper intestinal endoscopy were monitored by both pulse oximetry and chest EKG. Fifty-seven patients between the ages of 6 weeks and 36 months underwent 60 flexible upper intestinal endoscopies. All patients received parenteral sedation only. All procedures were successfully performed without significant complications. In 53 of the patients there was only transient mild oxygen desaturation with introduction of the endoscope into the pharynx and upper esophagus. In contrast, in seven patients, oxygen desaturation to less than 90% was noted following sedation but prior to insertion of the endoscope without overt clinical evidence of complications. Oxygen administered by nasal cannula resulted in a return of the oxygen saturation to at least the preprocedural level and allowed for safe completion of the studies. With improved monitoring, the use of smaller, more flexible endoscopes, and more experience, routine general anesthesia in children less than 3 years of age, as recommended in the past, may not be mandatory. Pulse oximetry may be particularly useful as an early indicator of poor oxygenation and may provide an objective means to assess the need for supplemental oxygen and to determine the degree of postprocedural observation.
Subject(s)
Endoscopy, Gastrointestinal/methods , Oximetry , Child, Preschool , Chlorpromazine/therapeutic use , Endoscopy, Gastrointestinal/adverse effects , Humans , Infant , Meperidine/therapeutic use , Oxygen/administration & dosage , Oxygen/bloodABSTRACT
Guidelines for management in the asymptomatic patient with a smooth-blunt gastric foreign body are not well established in the pediatric literature. Questionnaires were sent to pediatricians, family practitioners, pediatric gastroenterologists and pediatric surgeons with an over-all response rate of 62.2%. There was no agreement in regard to how long one should observe such patients before recommending intervention. There was no correlation of years of clinical experience and length of observation recommended either. Review of the pre-endoscopic literature revealed spontaneous evacuation in 93-99% of all types of foreign bodies in 1477 pediatric patients. An observation period of at least eight weeks should be strongly considered in an asymptomatic patient with a smooth-blunt gastric foreign body. Exceptions would include an anatomic abnormality of the gastric outlet, previous gastric outlet surgery as well as a possibly toxic object.
Subject(s)
Foreign Bodies/therapy , Stomach , Humans , Surveys and QuestionnairesABSTRACT
Eight pediatric patients with presenting symptoms of chronic diarrhea, abdominal cramps, weight loss, and/or recurrent emesis were diagnosed as having giardiasis by duodenal brush cytology. All patients had at least three stool specimens examined for ova and parasites, which failed to reveal Giardia lamblia cysts or trophozoites. In each patient, the small intestinal mucosal biopsies as well failed to reveal giardia. No complications were encountered during any of the procedures. Duodenal brush cytology for giardiasis appears to be a valuable diagnostic adjunct potentially superior to stool examination as well as endoscopic grasp small bowel biopsy.
Subject(s)
Giardiasis/diagnosis , Child , Child, Preschool , Cytological Techniques , Duodenum/parasitology , Endoscopy , Female , Giardiasis/parasitology , Humans , Infant , Intestinal Mucosa/parasitology , MaleABSTRACT
Twenty-three pediatric patients with blunt esophageal foreign bodies underwent flexible endoscopic removal without general anesthesia. No object was in place longer than 14 days. In 18 patients the foreign body was successfully removed, while in five patients the object was dislodged into the stomach. All of the latter patients were encountered early in the series. No complications were encountered in any patients. This technique appears to be a safe alternative to other proposed methods of blunt esophageal foreign-body removal.
Subject(s)
Esophagoscopy , Esophagus , Foreign Bodies/therapy , Child , Child, Preschool , Fiber Optic Technology , Humans , InfantABSTRACT
Seven patients with cystic fibrosis who had complications of gastroesophageal reflux including abdominal pain, peptic esophagitis, upper gastrointestinal hemorrhage, and esophageal stricture are described. We believe that these are gastrointestinal complications of CF and that they may be responsible for significant morbidity. The mechanical influence of a depressed diaphragm caused by hyperinflation, along with increased abdominal pressure with chronic coughing, may contribute to GER in CF. Early detection and treatment are important not only to prevent esophageal complications but also to increase the quality of life by relief of pain and by avoiding the resultant decrease in appetite, which can contribute to malnutrition.
Subject(s)
Cystic Fibrosis/complications , Gastroesophageal Reflux/etiology , Adolescent , Adult , Antacids/therapeutic use , Child , Cimetidine/therapeutic use , Esophageal Stenosis/etiology , Esophageal Stenosis/therapy , Esophagitis, Peptic/etiology , Female , Gastroesophageal Reflux/diagnosis , Gastroesophageal Reflux/therapy , Humans , Hydrogen-Ion Concentration , Male , PostureABSTRACT
Fifty children, ages 1 month to 12 years, underwent peroral jejunal biopsy with a four-way directional suction biopsy instrument (Medi-Tech). Mucosal specimens were obtained in 88% of attempted biopsies in an average time of 4 min. Fluoroscopy time was minimal, and there were no complications.
Subject(s)
Biopsy/instrumentation , Intestine, Small/pathology , Child , Child, Preschool , Humans , Infant , Infant, Newborn , Intestinal Mucosa/pathologyABSTRACT
A case of pulmonary vasculitis complicating ulcerative colitis is presented, and the literature is reviewed. Unexplained pulmonary problems complicating severe ulcerative colitis should prompt a review of rare etiologies to include pulmonary vasculitis, apical pulmonary fibrosis, and salicylazosulfapyridine-induced lung disease. Lung biopsy will establish a diagnosis of pulmonary vasculitis.
