Paediatric digestive endoscopy: From conventional endoscopy to endoscopic ultrasound and endoscopic retrograde cholangiopancreatography

Table 1 Diagnostic and therapeutic indications and types of endoscopes in pediatric gastrointestinal endoscopy

Procedure	Diagnostic indications	Therapeutic indications	Types of endoscopes
Esophagogastroduodenoscopy	Hematemesis, hematochezia, and melena	Foreign body removal	< 10 kg or < 1 year: ≤ 6 mm gastroscope is preferred. Consider a standard adult gastroscope if endotherapy is required
	Dysphagia or odynophagia	Percutaneous endoscopic gastrostomy	≥ 10 kg or ≥ 1 year: Standard adult gastroscope. Therapeutic gastroscope (if needed)
	Unexplained recurrent vomiting	Duodenal tube placement
	Unexplained chronic diarrhea	Food impaction
	Abdominal pain with suspicion of an organic disease	Haemostasis
	Weight loss and failure to thrive	Stricture dilation
	Caustic ingestion	Achalasia pneumodilation or occasionally botulinum injection
	Chronic GERD to exclude other diseases or surveillance of Barrett's esophagus	Polypectomy
	Gastrointestinal allergy
	Unexplained Iron-deficiency anemia
	Malabsorption syndrome
Ileo-colonoscopy	Unexplained weight loss or failure to thrive	Polypectomy	< 10 kg or < 1year: Ultrathin gastroscope (≤ 6 mm), standard adult gastroscope, or pediatric colonoscope
	Unexplained chronic diarrhea	Endomucosal resection	≥ 10 kg or ≥ 1 year: Paediatric or adult colonoscope (12-14 mm)
	Rectal bleeding	Submucosal dissection
	Perianal lesions (abscess and fistula)	Haemostasis
	Unexplained anaemia	Stricture dilation
		Reduction of sigmoidal volvulus
Single- or double-balloon small-bowel enteroscopy	Suspected Crohn's disease	Polypectomy	For more than 10 kg, if the diameter of the overture is tolerable
		Haemostasis
		Stricture dilation
Endoscopic ultrasound	Enteric duplication (esophageal, gastric or duodenal)	Pancreatic pseudocyst	< 10 kg or < 1 year: Miniprobe or 7.4 mm EBUS
	Congenital esophageal stenosis	Pancreatic disease	≥ 10 kg or ≥ 1 year: Miniprobe or 7.4 mm EBUS scope
	Diagnosis and staging of neoplasms		≥ 15 kg or ≥ 3 years: Adult radial/linear echoendoscope.
	Bile duct stones
	Pancreatic pseudocyst
Endoscopic retrograde cholangiopancreatography	Cholestasis in neonates and infants	Bile duct stones	< 10 kg or < 1 year: 7.5 mm duodenoscope
	Choledochal cyst	Benign biliary strictures	≥ 10 kg or ≥ 1 year: Therapeutic duodenoscope (4.2 mm operative channel)
	Primary sclerosing cholangitis (brush cytology)	Malignant biliary strictures
		Bile/pancreatic duct leak
		Parasitosis (ascariasis, fascioliasis)
		Chronic pancreatitis
		Recurrent acute pancreatitis
		Pancreas divisum

EBUS: Endobronchial ultrasound.