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Practical Pediatric Gastrointestinal Endoscopy


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Vernon‐Edwards) were, and have been, pivotal in financial help to make the Unit the most fantastic place to work ‐ the Endoscopy Unit of the Future, the double balloon enteroscopy set up, the wireless capsule endoscopy service and the new magnetic‐controlled capsule technology, and most recently the Symbionix virtual endoscopy training simulator, are amongst a few of the things that they have kindly and generously funded for us, allowing us to stay at the cutting edge of training and diagnostic and endo‐therapeutic capability.

      My endoscopic ‘raison d’être’ is to attempt to put the paediatric surgeons out of work! Hence pushing the boundaries in such areas as are covered in this Textbook. Nevertheless, I think it is critical that we work hand in hand with our surgical colleagues, many of who perform endoscopy, in order to blur the interface between our approaches. I am extremely fortunate to work with some fantastic and enlightened individuals in the surgical team and we are almost a joint Unit nowadays – as can be seen by our innovations with laparoscopic assisted endoscopic percutaneous jejunostomy and duodenal web division, amongst many others. Maybe I am a frustrated surgeon after all! Hopefully the web page is educational to those that access it with many videos etc. I am particularly indebted to the open‐minded attitude and team‐spirited nature of Mr Sean Marven, Mr Richard Lindley, Prof Ross Fisher, Mr Suresh Murthi, Prof Prasad Godbole, Ms Emma Parkinson, and more recently Ms Liz Gavens and Ms Caroline McDonald. Sparring with Jenny Walker was always fun and we are now good friends. Rang Shawis and Julian Roberts should not be missed out here.

      Endoscopy in the modern world in children could not occur ‐ especially endo‐therapeutic ‐ without the excellence of our anaesthetists ‐ my stars are Dr David Turnbull, Dr Liz Allison, Dr Kate Wilson, Dr Rob Hearn, Dr George Colley at the Royal Free, and most importantly of all, the best paediatric anesthetist of them all, Dr Adrian Lloyd‐Thomas (AL‐T). A quick story ‐ the modern practice of topical application of Mitomycin C after esophageal dilation came from a chance conversation with AL‐T, who told me that the ENT guys used Mitomycin C post‐laryngeal reconstruction to prevent circumferential stenosis ‐ we tried it and it worked in the esophagus of a girl requiring multiple frequent esophageal dilation. Cue a paper in The Lancet. Perhaps we should have more cross‐specialty conversations?

      We should remember that this is the only truly ‘procedure‐specific’ paediatric specialty and stick to our guns with respect of the importance of endoscopy in our training. The Guidelines and Position Papers, some joint with ESGE and NASPGHN have been extremely well received and, in addition, have helped in raising the JPGN Impact Factor to its new dizzying height of nearly 3.

      Medicine is a vocation amongst us of course, and training the next generation has been one of my major aims. In this I am particularly grateful to Prof Sanja Kolacek in her unswerving support and application of her considerable energy in moving forward the recent amazing ESPGHAN Endoscopy Fellowship Program ‐ worth mentioning again!

      We should, in my view, never compromise on the quality of training or care delivery afforded by paediatric endoscopy by those of us fortunate enough to have benefitted by it in our careers. Adult GI endoscopists should be involved only if we cannot avoid it ‐ that comes down to our learning the correct skills and techniques and making their involvement redundant. We still have plenty to learn from them though, I will acknowledge.

      Thank you to the numerous members of the endoscopy Companies that have been so helpful over the years with Courses etc etc. You will know who you are but to numerous to mention here.

      Kevin and Kat in ESPGHAN Head Office have always been very receptive to any Qs needed and I am grateful to them.

      There is no ceiling to what we can achieve in pediatric endoscopy. Attending ‘adult’ GI and endoscopy meetings is illuminating e.g. ‘ESGE Days’. We are no longer the Cinderella part of pediatric GI but we still need to achieve parity with the adult Societies ‐ a place at the ‘top table’ i.e. Societal Councils – as occurs in all adult GI Societies.

      I would like to thank all the trainees from so many countries and backgrounds for their personal commitment and sacrifice over the last 25 years in coming to train with us ‐ it never ceases to amaze me how mothers and fathers and spouses can leave their loved ones for months, on occasions a year or more, in order to train in this fantastic compelling area. Their ability to do so has been facilitated by my amazing Endoscopy Fellow and Course Coordinator, without whom it would have been truly impossible to run such a successful training program ‐ Sam Goult. Thankyou Sam.And then, if you have got this far then ‘well done’. It is so important to me to hold up my hand and say that, in all honesty, I could have not done all that I have done (admittedly a microcosm in the great scheme of things) without the forbearance and tolerance of my wife Kay and my exceptional and talented and kind daughters Ella, Jess and Flo. Incredible people and my driving force. I am sorry to you all for being away so much giving lectures and all that stuff when you were growing up and when you, Kay, were managing them so amazingly, almost single‐handedly. I would have done things differently if I had had the time again and know what I know now. Medicine as a job is not necessarily life, although some times it is difficult to see beyond the vocation.

      Lastly, I want to say a special thankyou to all the families and children that it has been my pleasure and privilege to help over the last 35 years.