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J Pediatr Gastroenterol Nutr. 2019 Jan 16. doi: 10.1097/MPG.0000000000002277. [Epub ahead of print]

Pediatric Endoscopy and High Risk Patients: A Clinical Report from the NASPGHAN Endoscopy Committee.

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Texas Children's Hospital, 1010 MW Tower, 6621 Fannin St, Houston, TX 77030.


Pediatric gastrointestinal endoscopy has been established as safe and effective for diagnosis and management of many pediatric gastrointestinal diseases. Nevertheless, certain patient and procedure factors should be recognized that increase the risk of intra and/or post procedural adverse events. Adverse events associated with endoscopic procedures can broadly be categorized as involving sedation-related physiological changes, bleeding, perforation and infection. Factors which may increase patient risk for such adverse events include but are not limited to, cardiopulmonary diseases, anatomical airway or craniofacial abnormalities, compromised intestinal luminal wall integrity, coagulopathies and compromised immune systems. Examples of high-risk patients include patients with congenital heart disease, craniofacial abnormalities, connective tissues diseases, inflammatory bowel disease and children undergoing treatment for cancer. This clinical report is intended to help guide clinicians stratify patient risks and employ clinical practices that may minimize adverse events during and after endoscopy. These include use of CO2 insufflation, endoscopic techniques for maneuvers such as biopsies, and endoscope loop-reduction to mitigate the risk of such complications such as bleeding and intestinal perforation. Endoscopic infection risk and guidance regarding peri-procedural antibiotics are also discussed.

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