Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore 119228, Singapore.
Department of Paediatrics, Yong Loo Lin School of Medicine National University of Singapore, Singapore 119228, Singapore.
World J Gastroenterol. 2023 May 14;29(18):2717-2732. doi: 10.3748/wjg.v29.i18.2717.
There has been a rapid expansion in the knowledge of paediatric gastroenterology over the recent decade, with a fast-growing repertoire of diagnostic techniques and management strategies for a wide spectrum of childhood gastrointestinal (GI) diseases. Paediatric GI endoscopy is a core competency every paediatric gastroenterologist should possess, and represents one of the most common procedures performed in children for both diagnostic and therapeutic purposes. Yet there remains a dearth of literature on the utility and outcomes of paediatric GI endoscopy in the Asia-Pacific region. Data on the diagnostic value of paediatric GI endoscopy would be an important aspect of discussion, with the emergence of inflammatory bowel disease (IBD) and eosinophilic GI disease as increasingly common endoscopic diagnoses. Time-based trends in paediatric GI endoscopy do point towards more IBD and gastroesophageal reflux disease-related complications being diagnosed, with a declining incidence of GI bleeding. However, the real-world diagnostic value of endoscopy in Asia must be contextualised to the region-specific prevalence of paediatric GI diseases. infection, particularly that of multidrug-resistant strains, remains a highly prevalent problem in specific regions. Paediatric functional GI disorders still account for the majority of childhood GI complaints in most centres, hence the diagnostic yield of endoscopy should be critically evaluated in the absence of alarm symptoms. GI therapeutic endoscopy is also occasionally required for children with ingested foreign bodies, intestinal polyposis or oesophageal strictures requiring dilation. Endoscopic haemostasis is a potentially life-saving skill in cases of massive GI bleeding typically from varices or peptic ulcers. Advanced endoscopic techniques such as capsule endoscopy and balloon-assisted enteroscopy have found traction, particularly in East Asian centres, as invaluable diagnostic and therapeutic tools in the management of IBD, obscure GI bleeding and intestinal polyposis. State of the art endoscopic diagnostics and therapeutics, including the use of artificial intelligence-aided endoscopy algorithms, real-time confocal laser endomicroscopy and peroral endoscopic myotomy, are expected to gain more utility in paediatrics. As paediatric gastroenterology matures as a subspecialty in Asia, it is essential current paediatric endoscopists and future trainees adhere to minimum practice standards, and keep abreast of the evolving trends in the diagnostic and therapeutic value of endoscopy. This review discusses the available published literature on the utility of paediatric GI endoscopy in Asia Pacific, with the relevant clinical outcomes.
在过去的十年中，儿科胃肠病学的知识迅速扩展，针对广泛的儿童胃肠道 (GI) 疾病，诊断技术和治疗策略不断增加。儿科胃肠内镜是每位儿科胃肠病学家都应具备的核心能力，也是儿童进行诊断和治疗的最常见程序之一。然而，关于亚太地区儿科胃肠内镜的实用性和结果的文献仍然很少。关于儿科胃肠内镜诊断价值的数据将是讨论的一个重要方面，随着炎症性肠病 (IBD) 和嗜酸性粒细胞性胃肠病作为越来越常见的内镜诊断出现。儿科胃肠内镜的基于时间的趋势确实表明，更多的 IBD 和胃食管反流病相关并发症被诊断出来，而胃肠道出血的发病率则下降。然而，亚洲内镜的实际诊断价值必须与特定地区儿童胃肠疾病的流行情况相结合。感染，特别是多药耐药株的感染，在特定地区仍然是一个高度流行的问题。儿科功能性胃肠疾病在大多数中心仍然占儿童胃肠道投诉的大多数，因此在没有报警症状的情况下，应严格评估内镜的诊断效果。对于因摄入异物、肠息肉或食管狭窄需要扩张的儿童，也偶尔需要进行胃肠治疗性内镜检查。在大量胃肠道出血（通常来自静脉曲张或消化性溃疡）的情况下，内镜止血是一种潜在的救生技能。胶囊内镜和气囊辅助内镜检查等先进的内镜技术在东亚中心已得到广泛应用，成为 IBD、隐匿性胃肠道出血和肠息肉病管理的宝贵诊断和治疗工具。包括人工智能辅助内镜算法、实时共聚焦激光内镜检查和经口内镜肌切开术在内的最先进的内镜诊断和治疗技术有望在儿科领域得到更广泛的应用。随着儿科胃肠病学作为亚洲的一个亚专科成熟，当前的儿科内镜医生和未来的受训者必须遵守最低实践标准，并跟上内镜诊断和治疗价值的不断发展趋势。这篇综述讨论了亚太地区儿科胃肠内镜实用性的现有文献，并介绍了相关的临床结果。
