Hayat Jamal O, Sirohi Rohit, Gorard David A
Gastroenterology Department, Wycombe Hospital, High Wycombe, Buckinghamshire HP11 2TT, UK.
Eur J Gastroenterol Hepatol. 2008 Jul;20(7):648-52. doi: 10.1097/MEG.0b013e3282f5e9b6.
Children often travel from district hospitals to teaching centres for endoscopic procedures by paediatric gastroenterologists. A 10-year district hospital experience of 'adult-service' gastroenterologists endoscoping children is reported with the aim of quantifying the workload, indications, sedation/anaesthesia practices, findings and safety of paediatric endoscopy performed by adult-service gastroenterologists.
Data on endoscopic procedures in patients younger than 16 years of age between 1997 and 2006 were obtained from hospital case-notes and computerized endoscopy/histology databases and were analysed.
A total of 174 procedures (118 gastroscopies, 41 colonoscopies and 15 flexible sigmoidoscopies) were performed in 162 children. The median (interquartile range) age was 11.5 (5-14) years. Sixty-nine percent of patients were referred by paediatricians and 31% by general practitioners /other adult specialties. Children referred as outpatients waited a total of 50 (23.5-95) days from referral to procedure. Inpatient children waited 3 (1-4) days for their procedure. General anaesthesia was used in 89% (63 of 71) endoscopic procedures in children aged below 11 years and 100% of 47 procedures in children aged below 6 years. In contrast, 96% (99 of 103) procedures in children aged 11 years or older were done in the endoscopy unit with intravenous or no sedation. Organic disease was identified from 90 (52%) procedures. The most common diagnoses were coeliac disease (41), inflammatory bowel disease (26), gastro-oesophageal reflux (six) and foreign body removal (seven). No endoscopic complications occurred.
General gastroenterologists supported by paediatricians can provide endoscopic services for children safely and promptly in their local hospital. This is appropriate for the management of common gastrointestinal problems affecting children.
儿童常从地区医院前往教学中心，由儿科胃肠病学家进行内镜检查。本文报告了“成人服务”胃肠病学家在地区医院为儿童进行内镜检查的10年经验，目的是量化成人服务胃肠病学家进行儿科内镜检查的工作量、适应症、镇静/麻醉方法、检查结果及安全性。
从医院病历及计算机化内镜检查/组织学数据库中获取1997年至2006年间16岁以下患者的内镜检查数据，并进行分析。
共对162名儿童进行了174例检查（118例胃镜检查、41例结肠镜检查和15例乙状结肠镜检查）。年龄中位数（四分位间距）为11.5（5 - 14）岁。69%的患者由儿科医生转诊，31%由全科医生/其他成人专科转诊。门诊转诊儿童从转诊到检查共等待50（23.5 - 95）天。住院儿童等待3（1 - 4）天进行检查。11岁以下儿童的71例内镜检查中有89%（63例）使用全身麻醉，6岁以下儿童的47例检查中有100%使用全身麻醉。相比之下，11岁及以上儿童的103例检查中有96%（99例）在内镜室进行，采用静脉镇静或不使用镇静剂。90例（52%）检查发现了器质性疾病。最常见的诊断为乳糜泻（41例）、炎症性肠病（26例）、胃食管反流（6例）和异物取出（7例）。未发生内镜检查并发症。
在儿科医生支持下，普通胃肠病学家可在当地医院安全、及时地为儿童提供内镜服务。这适用于儿童常见胃肠道问题的管理。
