Objectives and Study

The objective of this study was to review the indications, feasibility and complications of endoscopic cyst gastrostomy (E-CG) for the treatment of pancreatic pseudocysts in a paediatric tertiary care centre.

Methods

Retrospective chart was carried out from October 2013 – August 2022. Cyst gastrostomies were performed via 3.2mm therapeutic endoscope using needle knife (Cook Medical). Single/double pig tailed stents (7 Fr) were placed to maintain luminal patency and ensure continuous drainage. Patients were followed up to document complications, length of stay, biochemical remission and need for a definitive procedure.

Results

Conclusions

Endoscopic cyst gastrostomy is a safe and effective procedure for treatment of pancreatic pseudocysts in children, with minimal complications.

Objectives and Study

Standard capsule endoscopy (CE) is ineffective for upper gastrointestinal (GI) tract examination because it does not allow operator-controlled navigation of the capsule. Magnetically assisted capsule endoscopy (MACE) may offer a solution to these problems. This pilot study is aimed to evaluate the feasibility of MACE system in pediatric Crohn’s disease (CD) and if magnetic steering could enhance capsule gastric emptying when compared with standard CE.

Methods

Pediatric CD patients already studied by standard small bowel CE were enrolled. All participants swallowed a magnetically assisted CE and an external magnetic field navigator was used to guide the capsule through the upper GI tract. Maneuverability, completeness of the MACE examination and differences in the esophageal transit time (ETT), gastric transit time (GTT) and pyloric transit time (PTT) between standard CE and MACE were assessed.

Results

Ten patients [mean age 11,4 years (range 6-15); 60% male] were enrolled. Maneuverability was defined as good and fair in 60% and 40% of participants, respectively. Completeness of MACE examination was 95%, 65% and 92,5% in the esophagus, proximal and distal stomach, respectively. Transpyloric passage of the capsule under magnetic control was successfully performed in 80% of patients.

Magnetic intervention significantly increased ETT (P < 0.001) and reduced GTT and PTT (P = 0.002). No significant adverse events occurred.

Conclusions

MACE is a safe and feasible technique in children. Magnetic steering enhances capsule gastric emptying and facilitates capsule transpyloric passage when compared with standard CE.

Objectives and Study

Transnasal endoscopy (TNE) allows for endoscopic evaluation of the upper gastrointestinal tract while avoiding general anesthesia risk. In the pediatric age group, often bronchoscopes are used for performing TNEs, which precludes the evaluation of the stomach and duodenum due to shorter length and overall suboptimal visualization. In this study, we evaluated a novel ultrathin gastroscope (EvoEndo®) in children and adults.

Methods

This is a multicenter retrospective study between May and November 2022. There were a total of 6 participating sites in USA. Data was collected from electronic medical record. Primary outcome was safety and efficacy of EvoEndo® single use transnasal gastroscope. Secondary outcomes included procedure and encounter duration, and biopsy adequacy.

Results

Thirty-six patients were recruited. Indications included dysphagia, eosinophilic esophagitis and esophageal varices surveillance. Mean age was 16.1 years ± 6.1 (6-37 years) with male predominance (86.1%). 35/36 subjects underwent TNE for varying clinical indications and targeted anatomy. One procedure was aborted prior to initiation. 3 subjects underwent transnasal esophagoscopy (TN-Eso), 26 transnasal gastroscopy (TN-EG), and 3 transnasal esophagogastroduodenoscopy (TN-EGD). The procedure was successful in 91.4%. 3 procedures were unable to be completed. 50% underwent TNE for the first time. Biopsies were performed in all completed procedures except the 2 patients undergoing esophageal varices surveillance, and were adequate for histopathological analysis. Median procedure duration was 11 minutes (IQR: 7-16 minutes) and median visit duration was 33.5 minutes (IQR: 30-39 minutes). No significant adverse events occurred.

Conclusions

Ultrathin TNE using the EvoEndo® single use gastroscope was well tolerated and safe in the pediatric and adult age groups with a success rate similar to previously reported studies. User feedback noted EvoEndo’s single use gastroscopes provided improved visualization, further reach into the upper gastrointestinal tract, and a larger working channel allowing for diagnostic EGD in an efficient ambulatory setting without the need for general anesthesia.