Читать книгу Practical Pediatric Gastrointestinal Endoscopy - Группа авторов - Страница 20

The improvements that have occurred in instruments, sedation and anesthesia during the last 40 years have transformed pediatric endoscopy and gastroenterology. Pediatric gastroenterologists are now able to perform difficult diagnostic and therapeutic procedures that used to be left to the adult endoscopist, such as endoscopic ultrasonography. These procedures likely need to be concentrated in referral tertiary hospitals that can afford the costly equipment and specialized staff. These highly specialized units can safely count on such facilities as surgical and intensive care assistance, in case of adverse events because one should always bear in mind that endoscopy is an invasive procedure with inevitable risks. The constant progress in instrument quality has considerably enhanced the diagnostic power of endoscopy. Several instrument makers have implemented optical zooms but also more sophisticated methods such as dyeless virtual chromoendoscopy, Olympus Narrow Band Imaging (NBI®), Fujinon Flexible Spectral Imaging Color Enhancement (FICE®) and Pentax™ i‐Scan®.

Mechanical improvements have enhanced the maneuverability of the endoscopes, for instance the adjustable stiffness of colonoscopes that facilitates access to the whole colon, insertion into the ileocecal valve and exploration of the terminal ileum. Exploration of the upper GI tract beyond the proximal jejunum and the terminal ileum is also possible with the double balloon enteroscope [39], which permits not only visualization of small bowel lesions but also biopsies and polypectomy. The most spectacular progress has been the wireless video capsule endoscopy (WCE) which allows exploration of the complete small bowel [40,41] matched with an array of enteroscopes which can traverse the deepest parts of the small intestine to complement findings seen on the WCE.