Advances in Pediatric Diagnostic Endoscopy: A State-of-the-Art Review

Abstract

Pediatric endoscopy has revolutionized the way we diagnose and treat gastrointestinal disorders in children. Technological advances in computer processing and imaging continue to affect endoscopic equipment and advance diagnostic tools for pediatric endoscopy. Although commonly used by adult gastroenterologists, modalities, such as endomicroscopy, image-enhanced endoscopy, and impedance planimetry, are not routinely used in pediatric gastroenterology. This state-of-the-art review describes advances in diagnostic modalities, including image-enhanced endoscopy, confocal laser endomicroscopy, optical coherence tomography, endo functional luminal imaging probes, wireless motility/pH capsule, wireless colon capsule endoscopy, endoscopic ultrasound, and discusses the basic principles of each technology, including adult indications and pediatric applications, safety cost, and training data.

Role of Confocal Laser Endomicroscopy in Early Detection of Upper Gastrointestinal Malignancy in High Risk Patients

“…CLE can be employed to visualize luminal structures such as the esophagus, stomach, and colon, as well as ductal structures like the pancreatic and bile ducts. This optimization of endoscopic diagnosis through CLE leads to a reduction in unnecessary resections, avoids repeated biopsies, and ultimately mitigates the risks and financial burden associated with repetitive indiscriminate endoscopic exams (Lerner et al, 2022). The most significant use of CLE in the esophagus is for surveillance and interpretation of suspicious lesions in Barrett's esophagus.…”

Imaging and endoscopic tools in pediatric inflammatory bowel disease: What’s new?

“…Mainly used for adult assessments, endoscopic ultrasound (EUS) has thus far been focused on pancreatic and biliary tree disease. The use of EUS in IBD has been limited mainly to assess bowel wall thickness[ 15 ] as well as perianal fistula tracts[ 9 , 16 , 17 ]. Similar to perineal US, its use to assess perianal fistulas and transmural inflammation, with the advantage of timing during colonoscopy, is an important area for further exploration.…”

“…It is the only IBD tool we have to assess mucosal disease both macroscopically and microscopically. Over recent years, there have been improvements in the quality of endoscopes ( e.g., more high-definition images) as well as available endoscopic tools such as balloon dilators and endoscopic needles[ 16 , 18 ].…”

Endoscopy in pediatric polyposis syndromes: why, when and how

“…Finally, the surface characteristics of the polyp can be closely examined, including the use of magnifying endoscopy, chromoendoscopy and virtual chromoendoscopy. A number of proprietary virtual chromoendoscopy technologies are available, including NBI, FICE, and i-SCAN [20]. The most established convention to describe the surface characteristics of polyps is the narrow-band imaging international colorectal endoscopic classification [21].…”