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Practical Pediatric Gastrointestinal Endoscopy


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      15 Chapter 27Figure 27.1 Subtypes of achalasia on high‐resolution manometry: (a) I, (b) I...Figure 27.2 Diagnosis and treatment algorithm based on expert opinion and cu...Figure 27.3 Rigiflex dilator.Figure 27.4 Submucosal injection of methylene blue prior to mucosotomy.Figure 27.5 Lineal mucosal incision.Figure 27.6 Initial stage of tunnel development.Figure 27.7 Creation of a tunnel using an electrical knife and pressure from...Figure 27.8 Completion of the tunnel with exposed circular muscle.

      16 Chapter 28Figure 28.1 EndoCinch front‐mounted on the endoscope.Figure 28.2 Suction applied and full‐thickness tissue capture followed by ne...Figure 28.3 Endoscopic gastroplication. This figure shows the pattern of a z...Figure 28.4 View (J manoeuver) of a lax GE junction in a child with major re...Figure 28.5 EndoCinch pediatric series pH efficacy at one year.Figure 28.6 Significant improvement in the total QOLRAD score one and three ...Figure 28.7 The Full‐Thickness Plicator.Figure 28.8 Application of the Full‐Thickness Plicator.Figure 28.9 Retroverted views of stages of application of the Full‐Thickness...Figure 28.10 Distal end of the EsophyX device (a) and SerosaFuse fastener (b...Figure 28.11 Endoscopic images of gastroesophageal valves from two subjects ...Figure 28.12 Operation times comparing endoscopic, laparoscopic. and open fu...Figure 29.13 Hospital stay (days) comparing endoscopic, laparoscopic, and op...Figure 28.14 Total cost comparing endoscopic, laparoscopic, and open fundopl...Figure 28.15 The Stretta system. Use of a balloon to deliver radiofrequency ...Figure 28.16 Injection of liquid polymer into the esophageal mucosa. The Ent...

      17 Chapter 30Figure 30.1 Active bleeding F 1b from a duodenal ulcer.Figure 30.2 Adherent clot (F 2b) at the base of a gastric ulcer.Figure 30.3 A flat pigmented spot (F 2c) at the base of a duodenal ulcer.Figure 30.4 Clear base of a duodenal ulcer (F 3).Figure 30.5 Single‐use preloaded rotatable two‐pronged clips: a single clip....Figure 30.6 Over‐the‐scope clip.Figure 30.7 Delivery system.

      18 Chapter 31Figure 31.1 Large esophageal varices before and after band ligation.Figure 31.2 (a) EUS varices preinjection. (b) EUS varices with needle.Figure 31.3 Varices being banded.Figure 31.4 Varices with EUS probe.Figure 31.5 Cutting the catheter after glue injection prior to removal to pr...

      19 Chapter 32Figure 32.1 Algorithm for the management of OGIB in children. CE, capsule en...

      20 Chapter 33Figure 33.1 Finger indentation of the anterior gastric wall.Figure 33.2 Schematic representation of the safe tract technique. In this ca...Figure 33.3 Placement of the blue guidewire through the catheter. A sufficie...Figure 33.4 Internal view of a PEG tube alongside the anterior gastric wall....Figure 33.5 (a) Buried bumper syndrome. The gastrostomy bumper is no longer ...

      21 Chapter 34Figure 34.1 Indentation.Figure 34.2 Transillumination.Figure 34.3 Marking the site.Figure 34.4 T‐fastener device.Figure 34.5 Insert the preloaded needle.Figure 34.6 Release the suture thread.Figure 34.7 Bend the locking strip and push the inner hub.Figure 34.8 Pull the T‐bar against the mucosa.Figure 34.9 Slide and close suture lock.Figure 34.10 Gastric view of gastropexy.Figure 34.11 Abdominal view of gastropexy.Figure 34.12 Local anesthesia injection.Figure 34.13 Make the incision.Figure 34.14 Introduce the safety needle.Figure 34.15 Activate safety collar.Figure 34.16 Remove the safety needle while introducing the guidewire.Figure 34.17 Remove the safety needle while introducing the guidewire.Figure 34.18 Dilation of stoma tract.Figure 34.19 Endoscopic view of dilator.Figure 34.20 Remove the dilator.Figure 34.21 Measure the length.Figure 34.22 Continue dilation.Figure 34.23 Keep the endoscopic view.Figure 34.24 Rotate the dilator central part to release the peel‐away sheath...Figure 34.25 Rotate the dilator central part to release the peel‐away sheath...Figure 34.26 Remove the dilator and the guidewire, leaving the peel‐away she...Figure 34.27 Advance the button while peeling the sheath.Figure 34.28 Figure 34.29 Figure 34.30 Endoscopic view of the button revealed as the sheath is peeled ...Figure 34.31 Figure 34.32 Figure 34.33 Peel the sheath down to the skin and remove it.Figure 34.34 Figure 34.35 Figure 34.36 Gastric view of the single‐stage PEG.Figure 34.37 Abdominal view.

      22 Chapter 35Figure 35.1 Laparoscopic view of endoscopic light source seen through the sm...Figure 35.2 A Johan instrument is used to occlude the jejunum distal to the ...Figure 35.3 Simultaneous laparoscopic and endoscopic view of trocar inserted...Figure 35.4 Endoscopic view of wire grasped by biopsy forceps.Figure 35.5 PEJ placed – endoscopic (a) and laparoscopic (b) views showing P...

      23 Chapter 36Figure 36.1 Endoscopic view of the feeding tube beyond the pylorus.

      24 Chapter 37Figure 37.1 Long common channel with choledochal cyst.Figure 37.2 Long common channel with choledochal cyst and choledochocele.Figure 37.3 Two‐year‐old child with rhabdomyosarcoma. Cholangioscopic view w...Figure 37.4 Fluoroscopic view of a 4‐year‐old child with rhabdomyosarcoma du...Figure 37.5 Primary sclerosing cholangitis.Figure 37.6 Fourteen‐year‐old child with traumatic bile leak.Figure 37.7 Seven‐year‐old liver transplant recipient with anastomotic stric...Figure 37.8 Sixteen‐year‐old liver transplant recipient with acute liver fai...Figure 37.9 Fourteen‐year‐old liver transplant recipient with two plastic bi...Figure 37.10 Fourteen‐year‐old liver transplant recipient with fully covered...Figure 37.11 Thirteen‐year‐old child with pancreas divisum and cystic fibros...Figure 37.12 Sixteen‐year‐old child with stent placement cystgastrostomy for...

      25 Chapter 38Figure 38.1 Transgastric linear endo‐ultrasound needle puncture of a pancrea...Figure 38.2 The indentation into the gastric wall can be seen easily identif...Figure 38.3 After endo‐ultrasound has identified the cyst and a site which i...Figure 38.4 Grasping forceps are used to manipulate the stents (pig‐tailed [...Figure 38.5 The stents are endoscopically observed in the pseudocyst, and me...Figure 38.6 The endoscope is withdrawn from the pseudocyst.Figure 38.7 The endoscope is withdrawn from the stomach and the gastrocystos...

      26 Chapter 39Figure 39.1 Simple balloon dilation of web/diaphragm can be effective alone ...Figure 39.2 Guidewire of endoballoon passing through small apperture in web/...Figure 39.3 Endoballoon has been inflated and gentle traction allows membran...Figure 39.4 Dual‐channel endoscope allows deployment of the endoknife to inc...Figure 39.5 Adequate luminal patency achieved.

      27 Chapter 40Figure 40.1 Different types of alternating RF currents and specific tissue r...Figure 40.2 Temperature‐related tissue destruction always induced by RF curr...Figure 40.3 Snare preparation before polypectomy: marking of the so‐called c...Figure 40.4 Squeezing pressure. A 15 mm retraction of the wire into the plas...Figure 40.5 The polyp is within the wire loop.Figure 40.6 The snare is fully closed. Avoid excessive force to prevent ampu...Figure 40.7 Mechanical prophylaxis of bleeding with endo‐clips.Figure 40.8 (a) Tripod forceps. (b) Roth net.Figure 40.9 Hemostasis with argon plasma coagulation.

      28 Chapter 41Figure 41.1 (Top left) High‐definition white light images of a proximal asce...Figure 41.2 (Left) Conventional high‐definition white light views of a later...Figure 41.3 ( Left) Endoscopic mucosal resection of the lesion is indicated (...Figure 41.4 (Top left) Conventional high‐definition white light imaging of a...Figure 41.5 ( Left) Conventional white light views of the distal descending c...Figure 41.6 (Left/right) Confocal laser scanning endomicroscopic imaging usi...Figure 41.7 (Left/right) High‐power hematoxylin and eosin staining of the ba...Figure 41.8 ( Left) High‐definition white light imaging of the distal sigmoid...Figure 41.9 ( Left) High‐magnification (100×) chromoscopic colonoscopy (indig...

      29 Chapter 42Figure 42.1 Colonoscopic appearance of multiple adenomas >1 cm meriting refe...Figure 42.2 (a) Multiple pedunculated polyps in a 6‐year‐old Caucasian femal...Figure 42.3 (a) Multiple large gastric polyps in the stomach of a 15 year ol...

      30 Chapter 43Figure 43.1 (a) Suggested sitting method: TNE insertion pathway below the in...Figure 43.2 Suggested optimal area to pass the transnasal endoscope after in...Figure 43.3 Suggested midline area to pass transnasal endoscope from the pha...

      31 Chapter 44Figure 44.1 Intragastric balloon.Figure 44.2 Anchor attached to long polymer impermeable sleeve.Figure 44.3 The delivery device of the sleeve.Figure 44.4 The device introduced over the guidewire.Figure 44.5 The releasing of the device.Figure 44.6 The anchor attached to the duodenal mucosa.Figure 44.7 Pseudopolyps at the site of anchor attachment.

      32 Chapter