Successful Pancolonoscopy and Ileoscopy in Children

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Abstract
Summary: The purpose of this study was to collect prospective data regarding the quality, extent, and duration of pediatric pancolonoscopy performed by pediatric gastroenterology attending physicians and a fellow in training. Over 7 months, data were prospectively collected on 40 colonoscopic procedures. The cecum was reached in 37 cases (92.5%) and the terminal ileum in 35 cases (87.5%). When cases of stricture and equipment failure were excluded, these completion rates were 97 and 95%, respectively. The overall average duration for pancolonoscopy, ileoscopy, multiple biopsies, and polypectomy (where necessary) was 38 min. When attending physicians performed the procedure, the duration was 31 min; the duration was 37 min when the fellow completed the procedure and 45 min when the fellow required the attending physician to complete it. The average time taken to reach the cecum by the attending physician was 19 min (range, 8–32); by the fellow it was 25 min (range, 17–32), and by the combination it was 37 min (range, 11–59). The average time from cecum to terminal ileum was 3 min for all, with ranges of 1–12 min for the attending physician and 1–23 min for the fellow. The fellow initiated 24 procedures, of which the attending physician was required to complete 12, including all five procedures performed in the initial 2 months of the study, 7 of 13 in the next 3 months, and none of the six procedures in the last 2 months. Of the 40 examinations, the colon was normal in five (12.5%), and a specific diagnosis was made in 35. There were no complications due to the procedure itself, but two patients had mild self-limited adverse effects from the sedation. No child had any recall of the procedure. Pancolonoscopy with ileoscopy in children is sensitive and specific for diagnosis. It is well-tolerated by children when adequate sedation with close monitoring is used; it is safe when performed by experienced pediatric gastroenterologists or a fellow in training under close supervision. Trainees can acquire the skills necessary to perform this challenging procedure in children when they are closely supervised and guided in a dedicated pediatric gastroenterology program.

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