computer‐aided learning and remote learning. Pediatric endoscopists can now acquire detailed knowledge, techniques and experience in many pediatric endoscopic fields, including the role and indications of endoscopsy in pediatric gastrointestinal diseases; technique of upper gastrointestinal endoscopic examination; risk assessment; recognition of complications; application of sedation/GA; lesion recognition of gastrointestinal pathology; ideal ileocolonoscopy technique including resolution of loop formation.
Lesion recognition is an area which lends itself nicely to this technology as competency can be examined remotely. The techniques underlying competent endoscopy can be taught with videos in advance of hands‐on teaching and in this respect e‐learning or any platform allowing access to “distant” learning of techniques is superior to textbooks or other modalities. Furthermore, endotherapeutic techniques such as variceal and nonvariceal bleeding, gastrostomy insertion, balloon dilation of strictures etc. lend themselves to web‐based video learning of the techniques prior to hands‐on activity and training.
Various platforms have been devloped by organizations and societies such as ESPGHAN, ESGE, BSG, UEG, ASGE, etc, and these are readily available online.
The last and possibly most useful application of e‐learning is the ability to use it as an objective test of the user’s competency – particularly in lesion recognition and testing the individual’s knowledge generally of when and how to apply various techniques in pediatric endoscopy. It is envisaged that this may then contribute to any formative, summative, and ongoing assessments of a pediatric endoscopist’s ability.
Of course, many examples of lesions and best practice endoscopy also exist on the internet outside the formal concept of e‐learning.
See companion website for videos relating to this chapter topic: www.wiley.com/go/gershman3e
USEFUL WEBSITES
www.asge.org/home/education‐meetings/products/endoscopic‐learning‐library
www.ueg.eu/education/online‐courses
www.espghan.org/education/e‐learning
10 Indications for gastrointestinal endoscopy in childhood
Dalia Belsha, Jerome Viala, George Gershman, and Mike Thomson
Diagnostic and therapeutic endoscopy are as available now for children as they were in previous years for adults.
Ideally, a pediatric practitioner would perform these although in adolescents, adult GI practititoners are sometimes involved.
Updated diagnostic and management guidelines for common disorders including celiac disease (CD), gastroesophageal reflux (GER), eosinophilic esophagitis (EE), and inflammatory bowel disease (IBD) illustrate the central role for endoscopy in pediatric practice.
It is also recognized that therapeutic endoscopic approaches are widely available now and further broaden the referral spectrum – these include treatment of GI bleeding, gastrostomy insertion, dilation of strictures, polypectomy, and many others.
The advent of newer technologies allows the examination of hitherto inaccessible areas of the GI tract such as the mid‐small bowel by wireless capsule videoendoscopy and enteroscopy.
Introduction
Endoscopic examination of the gastrointestinal tract (GIT) for diagnostics and therapy has evolved markedly over the last 20 or so years and is now usually undertaken by pediatric endoscopists. Updated diagnostic and management guidelines for common disorders including celiac disease (CD), gastroesophageal reflux (GER), eosinophilic esophagitis (EE) and inflammatory bowel disease (IBD) illustrate the central role for endoscopy. It is also recognized that therapeutic endoscopic approaches are widely available now and further broaden the referral spectrum – these include treatment of GIT bleeding, gastrostomy insertion, dilation of strictures, polypectomy, and many others. Lastly, the advent of newer technologies allows the examination of hitherto inaccessible areas of the GIT such as the mid‐small bowel by wireless capsule videoendoscopy and enteroscopy. This chapter is more symptom focused as the place of endoscopy in various pathologies is covered in the relevant chapters later on.
Changing indications for pediatric endoscopy over the last 25 years may have also influenced other disease detection rates such as that of IBD. In prospective studies, pediatric IBD incidence rates are higher than had been reported previously, which might reflect a real increase but also may have been affected by acquisition bias secondary to wider availability of, and improvement in the quality of, endoscopic assessment
Figure 10.1 Suggested diagnostic algorithm of chronic vomiting. PPI, proton pump inhibitor.
Source: BMJ Publishing Group Ltd and the Royal College of Paediatrics and Child Health.
Figure 10.2 Suggested diagnostic algorithm of lower gastrointestinal bleeding.
Source: BMJ Publishing Group Ltd and the Royal College of Paediatrics and Child Health.
Figure 10.3 Suggested diagnostic algorithm for chronic abdominal pain.
Source: BMJ Publishing Group Ltd and the Royal College of Paediatrics and Child Health.
Figure 10.4 Suggested diagnostic algorithm of chronic diarrhea.
Source: BMJ Publishing Group Ltd and the Royal College of Paediatrics and Child Health.
Figure 10.5 Suggested initial management of upper gastrointestinal
