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Practical Pediatric Gastrointestinal Endoscopy


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12Figure 12.1 Unusually wide‐open anus. This finding is suspicious for spina b...Figure 12.2 Squamocolumnar junction or dentate line.Figure 12.3 The longitudinal folds in the distal rectum (columns of Morgani)...Figure 12.4 Semilunar folds of Houston in the rectum.Figure 12.5 Typical vascular pattern of the normal rectum.Figure 12.6 The sigmoid colon. The endoscopic markers of normal sigmoid colo...Figure 12.7 The angle is sharper when the descending colon extends down belo...Figure 12.8 The descending colon. The shape of the descending colon is close...Figure 12.9 The vascular pattern of the descending colon. The stems of the v...Figure 12.10 The splenic flexure. It is marked by bluish discoloration.Figure 12.11 The angle between the splenic flexure and transverse colon in r...Figure 12.12 The transverse colon. The triangular shape is the endoscopic ha...Figure 12.13 The hepatic flexure. The mucosa of this area is paler and has a...Figure 12.14 The hepatic flexure, which is dome shaped. The junction between...Figure 12.15 Appendiceal orifice and “bow and arrow sign”: the imaginary arr...Figure 12.16 A focal widening or bulging of the circular fold at the upper a...Figure 12.17 Lumen as a clock face. (a) Scope straight. (b) Tip up deflectio...Figure 12.18 Slightly depressed groove‐like area and merging folds are the s...Figure 12.19 The main submucosal veins and their branches. The main vessels ...Figure 12.20 Common locations of the lumen. (a) The lumen is located at 9 o’...Figure 12.21 Prominent taenia coli. An appearance of the taenia while approa...Figure 12.22 Schematic images of: (a) alpha loop, (b) N‐loop and (c) Scope G...Figure 12.23 Gamma loop in the transverse colon.Figure 12.24 The ileocecal valve. It is usually located between the 5 o’cloc...Figure 12.25 The terminal ileum. Velvety texture, yellowish tinge, and lymph...Figure 12.26 Ulcerative colitis. Diffuse inflammation is typical for ulcerat...Figure 12.27 The “cecal patch”: a focal inflammation of the appendiceal orif...Figure 12.28 Severe form of ulcerative colitis. (a) Narrowing of the lumen d...Figure 12.29 Multiple pseudopolyps. (a,b) Acute phase. (c) Endoscopic remiss...Figure 12.30 Aphthous ulcer. A small, 4–5 mm, shallow lesion with the rim of...Figure 12.31 Deep longitudinal ulcers in a patient with Crohn’s disease.Figure 12.32 (a) Mucosal bridging. (b) Colonic stricture.Figure 12.33 Allergic colitis. Multiple lymphoid follicles with rim of eryth...Figure 12.34 Small aphthoid‐like lesions can occasionally be induced by bowe...Figure 12.35 Numerous lymphoid follicles in the sigmoid colon.Figure 12.36 Multiple enlarged (more than 3 mm) lymphoid follicles in the te...Figure 12.37 Six‐year‐old boy with recurrent ileocolonic intussusceptions. I...Figure 12.38 Sessile juvenile polyp.Figure 12.39 Pedunculated juvenile polyp.Figure 12.40 Large juvenile polyp in the descending colon.Figure 12.41 The “chicken skin” sign. The mucosa around a large juvenile pol...Figure 12.42 Juvenile polyposis. Multiple juvenile polyps in the rectum and ...Figure 12.43 Multiple colon polyps in a 5‐year‐old boy with FAP.Figure 12.44 Adenocarcinoma of the right colon in an 11‐year‐old boy with si...Figure 12.45 Non‐Hodgkin’s lymphoma of the ileum. The indications for a colo...Figure 12.46 Langerhans cell histiocytosis of the colon: multiple yellowish ...Figure 12.47 Large hemangioma of the sigmoid colon in a 3‐year‐old girl with...Figure 12.48 Angiodysplasia of the colon in a child with recurrent low GI bl...Figure 12.49 Idiopathic colonic varices of the right colon in a 9‐year‐old b...Figure 12.50 Congenital colonic varices in a 3‐week‐old baby with hematochez...

      4 Chapter 13Figure 13.1 (a) GIT biopsies embedded in multicassettes (e.g., ABC). The mac...Figure 13.2 (a) Gastrointestinal sample embedded on edge, rendering a good v...

      5 Chapter 14Figure 14.1 Double‐balloon enteroscope system configuration.Figure 14.2 DBE technique.Figure 14.3 Double‐balloon tattoo.Figure 14.4 Polyp detected (a) and removed (b).Figure 14.5 Multiple angiomas in small bowel.Figure 14.6 Meckel’s diverticulum.Figure 14.7 (a) Blue rubber bleb nevus syndrome lesions. (b) Blue rubber ble...Figure 14.8 Single‐balloon enteroscopy.Figure 14.9 Spiral enteroscopy outside the patient.Figure 14.10 Spiral enteroscope advancing intraluminally.Figure 14.11 Extent of laparoscopic‐assisted enteroscopy.Figure 14.12 Intraoperative enteroscopy and transillumination of a discrete ...

      6 Chapter 15Figure 15.1 Occult bleeding from an angiodysplasia.Figure 15.2 Jejunal Peutz–Jeghers polyp.Figure 15.3 (a) Crohn’s disease. (b) A follow‐up study in a 16‐year‐old male...Figure 15.4 CMUSE or diaphragm disease.Figure 15.5 Lymphoma.Figure 15.6 Meckel's diverticulum.Figure 15.7 NSAID lesions.Figure 15.8 Crohn’s aphthoid ulcers and stricture.Figure 15.9 Celiac disease.Figure 15.10 Methods of “front‐loading” the PillCamTM onto a gastroscope. (a...Figure 15.11 Intestinal lymphangiectasia.Figure 15.12 Intestinal intussusception.Figure 15.13 Images obtained with an esophageal capsule.Figure 15.14 Colon capsule.Figure 15.15 Mechanism for magnetic capsule propulsion.

      7 Chapter 16Figure 16.1 Ultrasound catheter probe.Figure 16.2 Front‐loading ultrasound probe.Figure 16.3 Radial scan ultrasound. Distal tip of echo‐endoscope with balloo...Figure 16.4 Linear scan ultrasound video endoscope. Distal tip of echo‐endos...Figure 16.5 The linear probe with advanced aspiration/biopsy needle.Figure 16.6 EUS of the needle (double arrow) advanced into a pancreatic pseu...Figure 16.7 Orientation of a FNA needle advanced through the operative chann...Figure 16.8 (a) Esophagus wall; the first inner hyperechoic (bright) layer i...Figure 16.9 Esophageal anastomotic stenosis: thickening of concentric layers...Figure 16.10 Esophageal duplication marked by arrow.Figure 16.11 Congenital stenosis with aberrant cartilaginous remnants (white...Figure 16.12 Gastrointestinal stromal tumor (GIST) (arising from submucosal ...Figure 16.13 GIST‐FNA. Arrow points toward the FNA within the labeled mass (...Figure 16.14 Gastric lymphoma (distortion of the gastric wall and enlarged l...Figure 16.15 Duodenal duplication.Figure 16.16 Plicate hypertrophy of the stomach related to Helicobacter pylo...Figure 16.17 Duodenal web.Figure 16.18 Choledocholithiasis: two stones (arrow) in the dilated common b...Figure 16.19 Autoimmune pancreatitis (white arrow pointing at fullness in pa...Figure 16.20 Pancreatic pseudocyst. (a) Hypoechoic/anechoic cyst (white arro...

      8 Chapter 17Figure 17.1 The tip of a pediatric ERCP catheter pushed through the biopsy c...Figure 17.2 Endoscopic view of Barrett’s esophagus: (a) plain close view; (b...Figure 17.3 Endoscopic view of the distal duodenum in a patient with celiac ...Figure 17.4 Immersion chromoendoscopy after methylene blue spray, without pr...Figure 17.5 In a patient with familial adenomatous polyposis coli, flat (a) ...Figure 17.6 Colonic polyps before and after chromoendoscopy. (a) Hyperplasti...

      9 Chapter 18Figure 18.1 Confocal laser endomicroscope (Pentax).Figure 18.2 Comparison of confocal images with conventional histological ima...Figure 18.3 Comparison of confocal images with conventional histological ima...Figure 18.4 (a) Inflammatory bowel disease showing bifid crypt pattern, cryp...Figure 18.5 CLE of GVHD showing nuclear debris representing apoptotic bodies...

      10 Chapter 20Figure 20.1 Friability, edema, and erythema of varying degrees eventually as...Figure 20.2 Endoscopic characteristics of herpes esophagitis including mucos...Figure 20.3 Similar characteristics are shown in this figure.Figure 20.4 In epidermolysis bullosa, narrowing of the esophagus is more pro...Figure 20.5 Crohn’s esophageal involvement is usually with aphthoid ulcerati...Figure 20.6 Radiation‐ or chemotherapy‐induced esophagitis can be significan...

      11 Chapter 21Figure 21.1 Exudate – whitish coating on the esophageal surface. Exudate rep...Figure 21.2 Circumferential rings along the length of the esophagus. This fi...Figure 21.3 Mucosal edema and linear furrows. These finding are representati...Figure 21.4 Longitudinal rent. This split can occur with the passage of the ...Figure 21.5 Food impaction present in the esophageal lumen. Mucosa is edemat...

      12 Chapter 23Figure 23.1 (a) Endoscopy with water immersion showing normal villus pattern...Figure 23.2 (a) Duodenal biopsy specimen with bottom opened and oriented on ...

      13 Chapter 25Figure 25.1 Complex esophageal stricture secondary to caustic ingestion.Figure 25.2 Congenital esophageal stenosis with tracheal remnants.Figure 25.3 (a) Fluoroscopic appearance of a balloon waist. The arrow shows ...Figure 25.4 Incisions of the scar performed using a needle knife and a cutti...Figure 25.5 Two‐year‐old boy with complex esophageal stricture due to causti...Figure 25.6 The Dynamic Stent®.Figure 25.7 (a) The Dynamic Stent® in correct position. The two radiopaque b...

      14 Chapter 26Figure 26.1 Grade I corrosive esophagitis with diffuse erythema and minimal ...Figure 26.2 Grade IIa corrosive esophagitis: extensive mucosal sloughing.Figure 26.3 Grade IIb of corrosive esophagitis: multiple ulcerations.Figure 26.4 Corrosive gastritis.Figure