What is paediatric Endoscopy?
What is Endoscopy?
Endoscopy is a broad term for two procedures:
Gastroscopy or Upper Gastrointestinal Endoscopy
The Gastroscope is passed into the back of the throat to investigate the oesophagus (food pipe), stomach and duodenum (1st part of small intestine)
Ileo-colonoscopy or Lower Gastrointestinal Endoscopy
The Colonoscope is passed via the back passage looks into all of the large intestine and ileum (end part of small intestine). In the caecum the inside of the appendix can also be seen. The colon needs to be clear before the procedure. We use laxatives (bowel prep) one day before the procedure
Is paediatric endoscopy different from adult endoscopy?
Yes it is.
We need smaller endoscopes and technically smaller bowels are harder to endoscope
Children do not understand pain hence we do all procedures under general anaesthetic (not awake). This is also in keeping with national UK guidance for paediatric endoscopy
We need specialized anaesthetics experience in anaesthetizing children
How is paediatric endoscopy done at the Hampshire Clinic ?
I am an experienced Paediatric Endoscopist (diagnostic and thereapeutic) working in a Tertiary Paediatric Gastroenterology University Hospital Service and am the lead and trainer for paediatric endoscopy in Southampton. I am also the national Chair for the endoscopy working group BSPGHAN. I have endoscoped (diagnostic & interventional) all paediatric age ranges (premature babies to 18 years old teenagers)
Biopsies taken at endoscopy need to be interpreted by experienced paediatric histopathologists and we use the services of Unilabs® (Independent Histopathologists based in London). Children biopsies require special expertise for interpretation.
Your child will be our responsibility and care is offered by a very experienced paediatric team who ensure safe, satisfactory, comfortable and a pain free procedure. We do NOT use sedation
There is no overnight stay for the endoscopic procedures
What risks or complications may occur?
Fortunately, we have never seen any complications with any of the endoscopies at the Hampshire Clinic and we make every effort to ensure the endoscopy is safe. Still, every procedure has risks. The anaesthetic risks will be discussed by the anaesthetist on the day.
Bleeding may occur from a biopsy site but it usually stops and settles. In addition gastroscopy may result in perforation of the oesophagus or stomach but this is very rare. The risk is higher in case of an abnormal stricture or narrowing which needs stretching with a balloon. All possible interventional endoscopies, if planned or likely, will be discussed.
A colonoscopy may result in perforation of the colon but this is rare. The risk is higher if a polyp is removed.
The endoscopy may be incomplete if there is difficulty in passing the endoscope of a possible risk of perforation is perceived tude to presence of severe inflammation
Intestine lining under the microscope
My published Scientific Papers on Paediatric Endoscopy
Narula P, Broughton R, Howarth L, Piggott A, Bremner R, Tzivinikos C, Gillett P, Henderson P, Rawat D, Cullen M, Loganathan S, Devadason D, Afzal NA, Maginnis J, McKenna S, Thomson M, Green J, Johnston D. Paediatric Endoscopy Global Rating Scale: Development of a Quality Improvement Tool and Results of a National Pilot. J Pediatr Gastroenterol Nutr. 2019 Apr
Oliva S, Thomson M, de Ridder L, Martín-de-Carpi J, Van Biervliet S, Braegger C, Dias JA, Kolacek S, Miele E, Buderus S, Bronsky J, Winter H, Navas-López VM, Assa A, Chong SKF, Afzal NA, Smets F, Shaoul R, Hussey S, Turner D, Cucchiara S. Endoscopy in Pediatric Inflammatory Bowel Disease: A Position Paper on Behalf of the Porto IBD Group of the European Society for Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr. 2018 Sep;67(3):414-430
Ashton JJ, Bonduelle Q, Mossotto E, Coelho T, Batra A, Afzal NA, Vadgama B, Ennis S, Beattie RM. Endoscopic and Histological Assessment of Paediatric Inflammatory Bowel Disease Over a 3-Year Follow-up Period. J Pediatr Gastroenterol Nutr. 2018 Mar;66(3):402-409
Rahman I, Patel P, Boger P, Thomson M, Afzal NA. Utilisation of magnets to enhance gastrointestinal endoscopy. World J Gastrointest Endosc. 2015 Dec 25;7(19):1306-10. doi: 10.4253/wjge.v7.i19.1306.
Rahman I, Afzal NA, Patel P. The role of magnetic assisted capsule endoscopy (MACE) to aid visualisation in the upper GI tract. Comput Biol Med. 2015 Mar 24. pii: S0010- 4825(15)00092-X. doi: 10.1016/j.compbiomed.2015.03.014.
Rahman I, Patel P, Boger P, Rasheed S, Thomson M, Afzal NA. Therapeutic upper gastrointestinal tract endoscopy in Paediatric Gastroenterology. World J Gastrointest Endosc. 2015 Mar 16;7(3):169-82
Thomson M, Antao B, Hall S, Afzal N, Hurlston P, Swain CP, Fritscher-Ravens A. Medium-term outcome of endoluminal gastroplication with the EndoCinch device in children. Journal of pediatric gastroenterology and nutrition. Sep 2008;46(2):172-7
Afzal NA, Thomson M. Interventional endoscopy: recent innovations. Pediatric Gastrointestinal Disease. Pathophysiology, diagnosis and management (Textbook). 5th edition. 2008
Castellaneta SP, Afzal NA, Greenberg M, Francavilla R, Deere H, Davies S, Murch SH, Walker-Smith JA, Thomson M. Diagnostic role of upper gastrointestinal endoscopy in paediatric inflammatory bowel disease. Journal of pediatric gastroenterology and nutrition. Sep 2004;39(3):257-61
Afzal NA, Albert D, Lloyd-Thomas A, Thomson M. A child with oesophageal strictures. Lancet 2002 Mar 23;359(9311):1032
Rosseneu S, Afzal N, Yerushalmi B, Ibarguen-Secchia E, Lewindon P, Cameron D, Mahler T, Schwagten K, Köhler H, Lindley KJ, Thomson M. Topical application of mitomycin-C in oesophageal strictures. Journal of pediatric gastroenterology and nutrition. 2007 Mar;44(3):336-41
Thomson M, Sharon H, Afzal N, Ashwood P, Fritscher-Ravens A, Swain P. Endoluminal gastroplication in children with gastro-oesophageal reflux disease: 1 year follow-up. Gut. Dec 2004;53(12):1745-50