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

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

To determine the clinical characteristics of children with gastrointestinal bleeding (GIB) who died during the course of their *** 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, *** 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 considering only 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 *** 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： Pediatrics Gastrointestinal hemorrhage Endoscopy Proton pump inhibitors Mortality Liver disease Hospital Information Systems Octreotide

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Percutaneous endoscopic gastrostomy and gastrooesophageal reflux in neurologically impaired children

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World Journal of Gastroenterology 2011年第2期17卷 191-196页

作者： mike thomson Prithviraj Rao David Rawat Tobias G Wenzl Centre for Paediatric Gastroenterology Royal Free and University College Medical School Centre for Paediatric Gastroenterology Sheffield Childrens NHS TrustWestern BankSheffieldS10 2TH United Kingdom Kinderklinik Universittsklinikum Aachen

AIM:To investigate the effects of percutaneous endoscopic gastrostomy(PEG) feeding on gastro-oesophageal reflux(GOR) in a group of these children using combined intraluminal pH and multiple intraluminal impedance(pH/MII) . METHODS:Ten neurologically impaired children underwent 12 h combined pH/MII procedures at least 1 d before and at least 12 d after PEG placement. METHODS:Prior to PEG placement(pre-PEG) a total of 183 GOR episodes were detected,156(85.2%) were *** PEG placement(post-PEG) a total of 355 episodes were detected,182(51.3%) were *** total number of distal acid reflux events statistically significantly increased post-PEG placement(prePEG total 27,post-PEG total 173,P=0.028) and themean distal pH decreased by 1.1 *** distal reflux index therefore also significantly increased post-PEG [pre-PEG 0.25(0-2) ,post-PEG 2.95(0-40) ].Average proximal pH was lower post-PEG but the within subject difference was not statistically significant(P=0.058) . Median number of non-acid GOR,average reflux height,total acid clearance time and total bolus clearance time were all lower pre-PEG,but not statistically significant. CONCLUSION:PEG placement increases GOR episodes in neurologically impaired children.

关键词： Percutaneous endoscopic gastrostomy Gastro-oesophageal reflux Multiple intraluminal impedance

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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

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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 *** 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 *** patients had both antegrade(trans-oral)and retrograde(transanal and via ileostomy)*** patient underwent DBE with planned laparoscopic *** remaining 6 had trans-oral examination *** median examination time was 118 min(range 95-195). No complications were *** 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 *** source of bleeding was identified in a further patient with *** was normal or revealed minor mucosal friability in the remaining 3 *** 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

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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 *** endoscopic assessment revealed a friable bleeding trans-pyloric multi-lobulated sessile *** to further significant upper gastrointestinal bleeding,polypectomy *** mucosal resection was performed with a grasp-and-snare technique using a dual channel operating *** was achieved by application of argon plasma coagulation where *** perforation *** debridement was required 6 wk after which the growth was excised completely with no further blood transfusion required after that *** examination confirmed ulcerated and inflamed hyperplastic *** discuss our endoscopic technique and discuss the reported gastrointestinal manifestation of MD in the literature.

关键词： Menkes’ disease Gastrointestinal bleeding Grasp and snare technique Polypectomy Gastric polyp

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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

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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

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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 ***： 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, ***： 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 rain） 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 *** 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 ***： 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： Confocal laser endomicroscopy Histology Pediatric Gastrointestinal mucosa Gastrointestinaldisorders

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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 ***: 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 ***: 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

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A FORTIFIED,LEED HOME FOR THE US GULF COAST:The How’s and Why’s of a Building System That Makes Sense

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Journal of Green Building 2010年第1期5卷 19-35页

作者： H.Ker thomson Durable Residential Builders LLC(DRB)

INTRODUCTION Houston is a city where the residential home building industry is dominated by *** are good traditions and bad ***,unfortunately,the traditional Houston approach-wood framing,fiberglass insulation,ventilated attics,etc.-I feel,lies in the bad tradition *** builders will tell you that they are building what the buying public ***,to a point,that is correct.

关键词： insulation LEED Houston

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