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Double balloon enteroscopy in children:Diagnosis,treatment,and safety

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World Journal of Gastroenterology 2010年第1期16卷 56-62页

作者： mike thomson Krishnappa Venkatesh Khalid Elmalik Willam van der Veer Maartan Jaacobs Centre for Paediatric Gastroenterology Sheffield Children's NHS Foundation Trust Department of Gastroenterology VU University Medical Center

AIM:To assess the feasibility and utility of double balloon enteroscopy(DBE)in the management of small bowel diseases in children. METHODS:Fourteen patients(10 males)with a median age of 12.9 years(range 8.1-16.7)underwent DBE; 5 for Peutz-Jeghers syndrome(PJ syndrome),2 for chronic abdominal pain,4 for obscure gastrointestinal (GI)bleeding,2 with angiomatous malformations(1 blue rubber bleb nevus syndrome)having persistent GI bleeding,and 1 with Cowden's syndrome with multiple polyps and previous intussusception.Eleven procedures were performed under general anesthesia and 3 with deep sedation. RESULTS:The entire small bowel was examined in 6 patients,and a length between 200 cm and 320 cm distal to pylorus in the remaining 8.Seven patients had both antegrade(trans-oral)and retrograde(transanal and via ileostomy)examinations.One patient underwent DBE with planned laparoscopic assistance.The remaining 6 had trans-oral examination only.The median examination time was 118 min(range 95-195). No complications were encountered.Polyps were detected and successfully removed in all 5 patients with PJ syndrome,in a patient with tubulo-villous adenoma of the duodenum,in a patient with significant anemia and occult bleeding,and in a patient with Cowden's syndrome.A diagnosis was made in a patient with multiple angiomata not amenable to endotherapy,and in 1 with a discrete angioma which was treated with argon plasma coagulation.The source of bleeding was identified in a further patient with varices.DBE was normal or revealed minor mucosal friability in the remaining 3 patients.Hence a diagnostic yield of 11/14 with therapeutic success in 9/14 was achieved. CONCLUSION:Double balloon enteroscopy can be a useful diagnostic and therapeutic tool for small bowel disease in children,allowing endo-therapeutic intervention beyond the reach of the conventional endoscope.

关键词： Double balloon enteroscopy Gastrointestinal Peutz Jeghers syndrome Wireless video capsule endoscopy Children

Mortality associated with gastrointestinal bleeding in children: A retrospective cohort study

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World Journal of Gastroenterology 2017年第9期23卷 1608-1617页

作者： Thomas M Attard Mikaela Miller Chaitanya Pant Ashwath Kumar mike thomson Department of Gastroenterology Children’s Mercy Hospital Clinical Decision Support Children’s Mercy Hospital Department of Gastroenterology The University of Kansas Hospital University of Missouri Medical School Sheffield Children’s Hospital Western Bank

AIM To determine the clinical characteristics of children with gastrointestinal bleeding (GIB) who died during the course of their admission.METHODS We interrogated the Pediatric Hospital Information System database, including International Classification of Diseases, Current Procedural Terminology and Clinical Transaction Classification coding from 47 pediatric tertiary centers extracting the population of patients (1-21 years of age) admitted (inpatient or observation) with acute, upper or indeterminate GIB(1/2007-9/2015). Descriptive statistics, unadjusted univariate and adjusted multivariate analysis of the associations between patient characteristics and treatment course with mortality was performed with mortality as primary and endoscopy a secondary outcome of interest. All analyses were performed using the R statistical package, v.3.2.3. RESULTS The population with GIB was 19528; 54.6% were male, overall mortality was 2.07%;(0.37% in patients with the principal diagnosis of GIB). When consideringonly the mortalities in which GIB was the principal diagnosis, 48% (12 of 25 principal diagnosis GIB mortalities) died within the first 3 d of admission, whereas 19.8% of secondary diagnosis GIB patients died with 3 d of admission. Patients who died were more likely to have received octreotide (19.8% c.f. 4.04%) but tended to have not received proton pump inhibitor therapy in the first 48 h, and far less likely to have undergone endoscopy during their admission(OR = 0.489, P < 0.0001). Chronic liver disease associated with a greater likelihood of endoscopy. Mortalities were significantly more likely to have multiple complex chronic conditions. CONCLUSION GIB associated mortality in children is highest within 7 d of admission. Multiple comorbidities are a risk factor whereas early endoscopy during the admission is protective.

关键词：儿科胃肠的出血内视镜检查法质子泵禁止者死亡肝疾病医院信息系统 Octreotide

Feasibility of confocal endomicroscopy in the diagnosis of pediatric gastrointestinal disorders

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World Journal of Gastroenterology 2009年第18期15卷 2214-2219页

作者： Krishnappa Venkatesh Marta Cohen Clair Evans Peter Delaney Steven Thomas Christopher Taylor Ashraf Abou-Taleb Ralf Kiesslich mike thomson Centre for Pediatric Gastroenterology Sheffield Children's NHS Foundation TrustSheffieldS10 2THUnited Kingdom Department of Histopathology Sheffield Children's NHS Foundation TrustSheffieldS10 2THUnited Kingdom Optiscan PO Box 1066Mt WaverleyMDCVictoriaAustralia 3149Australia I.Med.Klink und Poliklinik Johannes Gutenberg University of MainzMainz 55131Germany

AIM:To evaluate the feasibility and utility of confocal laser endomicroscopy(CLE) in the description of normal gastrointestinal(GI) mucosa and in the diagnosis of GI disorders in children,in comparison to histology.METHODS:Forty-four patients(19 female) median age 10.9 years(range 0.7-16.6 years) with suspected or known GI pathology underwent esophago-gastro-duodenoscopy(OGD)(n = 36) and/or ileocolonoscopy(IC)(n = 31) with CLE using sodium fluorescein and acriflavine as contrast agents.Histological sections were compared with same site confocal images by two experienced pediatric and GI histopathologists and endoscopists,respectively.RESULTS:Duodenum and ileum were intubated in all but one patient undergoing OGD and IC.The median procedure time was 16.4 min(range 7-25 min) for OGD and 27.9 min(range 15-45 min) for IC.A total of 4798 confocal images were compared with 153 biopsies from the upper GI tract from 36 procedures,and 4661 confocal images were compared with 188 biopsies from the ileocolon from 31 procedures.Confocal images were comparable to conventional histology both in normal and in pathological conditions such as esophagitis,Helicobacter pylori gastritis,celiac disease,inflammatory bowel disease,colonic heterotopia,and graft versus host disease.CONCLUSION:CLE offers the prospect of targeting biopsies to abnormal mucosa,thereby increasing diagnostic yield,reducing the number of biopsies,decreasing the burden on the histopathological services,and reducing costs.

关键词：胃肠功能紊乱共聚焦诊断率活组织切片检查胃十二指肠镜小儿氧糖缺失幽门螺旋杆菌

Management of hyperplastic gastric polyp following upper gastrointestinal bleeding in infant with Menkes' disease

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World Journal of Gastrointestinal Endoscopy 2017年第7期9卷 341-345页

作者： Dalia Belsha Priya Narula Arun Urs mike thomson Centre of Paediatric Gastroenterology Sheffield Children’s HospitalSheffeld S10 2THUnited Kingdom

We report a case of an infant with Menkes' disease(MD) presented at the age of five months,with coffee ground vomiting,melaena with a significant drop of haemoglobin.Urgent endoscopic assessment revealed a friable bleeding trans-pyloric multi-lobulated sessile polyp.Due to further significant upper gastrointestinal bleeding,polypectomy occurred.Endoscopic mucosal resection was performed with a grasp-and-snare technique using a dual channel operating gastroscope.Haemostasis was achieved by application of argon plasma coagulation where required.No perforation occurred.Repeated debridement was required 6 wk after which the growth was excised completely with no further blood transfusion required after that procedure.Histological examination confirmed ulcerated and inflamed hyperplastic polyp.We discuss our endoscopic technique and discuss the reported gastrointestinal manifestation of MD in the literature.

关键词： Menkes 疾病胃肠的流血掌握和圈套技术 Polypectomy 胃的息肉

Review on sedation for gastrointestinal tract endoscopy in children by non-anesthesiologists

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World Journal of Gastrointestinal Endoscopy 2015年第9期7卷 895-911页

作者： Rok Orel Jernej Brecelj Jorge Amil Dias Claudio Romano Fernanda Barros mike thomson Yvan Vandenplas Children’s Hospital University Medical Centre Ljubljana Medical Faculty University of Ljubljana Department of Pediatrics Hospital S.Joo Pediatric Department University of Messina the Paediatric Section of the Portuguese Society of Anaesthesiology Department of AnesthesiologyHospital S.Joo Centre for Paediatric Gastroenterology International Academy of Paediatric Endoscopy TrainingSheffield Children’s Hospital Department of Pediatrics UZ BrusselVrije Universiteit Brussel1090 BrusselsBelgium

AIM: To present evidence and formulate recommendations for sedation in pediatric gastrointestinal(GI) endoscopy by non-anesthesiologists.METHODS: The databases MEDLINE, Cochrane and EMBASE were searched for the following keywords "endoscopy, GI", "endoscopy, digestive system" AND "sedation", "conscious sedation", "moderate sedation", "deep sedation" and "hypnotics and sedatives" for publications in English restricted to the pediatric age. We searched additional information published between January 2011 and January 2014. Searches for(upper) GI endoscopy sedation in pediatrics and sedation guidelines by non-anesthesiologists for the adult population were performed. RESULTS: From the available studies three sedation protocols are highlighted. Propofol, which seems to offer the best balance between efficacy and safety is rarely used by non-anesthesiologists mainly because of legal restrictions. Ketamine and a combination of a benzodiazepine and an opioid are more frequently used. Data regarding other sedatives, anesthetics and adjuvant medications used for pediatric GI endoscopy are also presented.CONCLUSION: General anesthesia by a multidisciplinary team led by an anesthesiologist is preferred. The creation of sedation teams led by non-anesthesiologists and a careful selection of anesthetic drugs may offer an alternative, but should be in line with national legislation and institutional regulations.

关键词： Gastro-intestinal endoscopy Gastroscopy Colonoscopy Sedatives Pediatric ages Anesthetics Analgesics

Challenges of banding jejunal varices in an 8-year-old child

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World Journal of Gastrointestinal Endoscopy 2015年第19期7卷 1350-1354页

作者： Dalia Belsha mike thomson Department of Paediatric Gastroenterology Sheffield Children Hospital

Endoscoic variceal ligation(EVL) by the application of bands on small bowel varices is a relatively rare procedure in gastroenterology and hepatology. There are no previously reported paediatric cases of EVL for jejunal varices. We report a case of an eight-yearold male patient with a complex surgical background leading to jejunal varices and short bowel syndrome, presenting with obscure but profound acute gastrointestinal bleeding. Wireless capsule endoscopy and double balloon enteroscopy(DBE) confirmed jejunal varices as the source of bleeding. The commercially available variceal banding devices are not long enough to be used either with DBE or with push enteroscopes. With the use of an operating gastroscope, four bands were placed successfully on the afferent and efferent ends of the leads of the 2 of the varices. Initial hemostasis was achieved with obliteration of the varices after three separate applications. This case illustrates the feasibility of achieving initial hemostasis in the pediatric population.

关键词： Endoscopic variceal ligation Endoscopichemostasis Pediatrics Gastrointestinal hemorrhage Varices Variceal banding

Utilisation of magnets to enhance gastrointestinal endoscopy

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World Journal of Gastrointestinal Endoscopy 2015年第19期7卷 1306-1310页

作者： Imdadur Rahman Praful Patel Philip Boger mike thomson Nadeem Ahmad AfzalImdadur Department of Gastroenterology University Hospital Southampton Department of Paediatric Gastroenterology the Children’s Hospital Sheffield Department of Paediatrics University Hospital Southampton

Methods to assess, access and treat pathology within the gastrointestinal tract continue to evolve with video endoscopy replacing radiology as the gold standard. Whilst endoscope technology develops further with the advent of newer higher resolution chips, an array of adjuncts has been developed to enhance endoscopy in other ways; most notable is the use of magnets. Magnets are utilised in many areas, ranging from endoscopic training, lesion resection, aiding manoeuvrability of capsule endoscopes, to assisting in easy placement of tubes for nutritional feeding. Some of these are still at an experimental stage, whilst others are being increasingly incorporated in our everyday practice.

关键词： Magnet Endoscopy Training Therapeutic Capsule Nutrition Child Paediatric Colonoscopy Imaging

Therapeutic upper gastrointestinal tract endoscopy in Paediatric Gastroenterology

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World Journal of Gastrointestinal Endoscopy 2015年第3期7卷 169-182页

作者： Imdadur Rahman Praful Patel Philip Boger Shahnawaz Rasheed mike thomson Nadeem Ahmad Afzal Department of Gastroenterology University Hospital Southampton SO16 6YD Southampton United Kingdom Department of Paediatrics University Hospital Southampton SO16 6YD Southampton United Kingdom Department of Surgery the Royal Marsden Hospital SW3 6JJ London United Kingdom Department of Paediatric Gastroenterology the Children's Hospital Sheffield Western Bank S10 2TH Sheffield United Kingdom

Since the first report of use of endoscopy in children in the 1970 s, there has seen an exponential growthin published experience and innovation in the field. In this review article we focus on modern age therapeutic endoscopy practice, explaining use of traditional as well as new and innovative techniques, for diagnosis and treatment of diseases in the paediatric upper gastrointestinal tract.

关键词： Child Pediatrics Endoscopy Gastroscopy Intestinal polyps Hemorrhage Caustics Gastrostomy Mitomycin Gastroesophageal reflux

The efficacy of vitamin E in preventing arthrofibrosis after joint replacement

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Animal Models and Experimental Medicine 2024年第2期7卷 145-155页

作者： Yingfang Fan Jean Yuh Sashank Lekkala Mehmet D.Asik Andrew thomson Madeline McCanne Mark A.Randolph Antonia F.Chen Ebru Oral Harris Orthopaedic Laboratory Department of Orthopaedic SurgeryMassachusetts General HospitalBostonMassachusettsUSA Department of Orthopaedic Surgery Harvard Medical SchoolBostonMassachusettsUSA Department of Surgery Harvard Medical SchoolBostonMassachusettsUSA Department of Orthopaedic Surgery Brigham and Women's HospitalBostonMassachusettsUSA

Background:Arthrofibrosis is a joint disorder characterized by excessive scar formation in the joint tissues.Vitamin E is an antioxidant with potential anti-fibroblastic effect.The aim of this study was to establish an arthrofibrosis rat model after joint replacement and assess the effects of vitamin E supplementation on joint fibrosis.Methods:We simulated knee replacement in 16 male Sprague–Dawley rats.We immobilized the surgical leg with a suture in full flexion.The control groups were killed at 2 and 12 weeks(n=5 per group),and the test group was supplemented daily with vitamin E(0.2 mg/mL)in their drinking water for 12 weeks(n=6).We performed histological staining to investigate the presence and severity of arthrofibrosis.Immunofluorescent staining andα2-macroglobulin(α2M)enzyme-linked immunosorbent assay(ELISA)were used to assess local and systemic inflammation.Static weight bearing(total internal reflection)and range of motion(ROM)were collected for functional assessment.Results:The ROM and weight-bearing symmetry decreased after the procedure and recovered slowly with still significant deficit at the end of the study for both groups.Histological analysis confirmed fibrosis in both lateral and posterior periarticular tissue.Vitamin E supplementation showed a moderate anti-inflammatory effect on the local and systemic levels.The vitamin E group exhibited significant improvement in ROM and weight-bearing symmetry at day 84 compared to the control group.Conclusions:This model is viable for simulating arthrofibrosis after joint replacement.Vitamin E may benefit postsurgical arthrofibrosis,and further studies are needed for dosing requirements.

关键词： arthrofibrosis range of motion total knee arthroplasty vitamin E