Pediatric Gastrointestinal Endoscopy: A Mature Subspecialty

Charles J. Lightdale, MD, Consulting Editor

The burden of gastrointestinal disease affecting infants and children is high and increasing. Fortunately, there are a growing number of specialists trained in both pediatrics and pediatric gastroenterology: enough to be available to most general pediatricians for evaluation and management of gastrointestinal illness. As in adults, gastrointestinal endoscopy has become a key element in the diagnosis and therapy of many diseases affecting children. It is certainly preferable to have endoscopies in children carried out by pediatric gastroenterologists who have specific knowledge and understanding of children’s diseases. There is more availability of such specialists for the performance of the most common upper and lower GI endoscopies. In addition, there is an increasing cadre of pediatric gastroenterologists who have been trained in advanced procedures, including enteroscopy, endoscopic retrograde cholangiopancreatography, and endoscopic ultrasonography.

It has been nearly 15 years since the last issue of Gastrointestinal Endoscopy Clinics of North America was devoted to pediatric endoscopy, and of course, there has been tremendous progress in the field. This is remarkably well documented in this terrific issue, which offers critical basic information needed to ensure the safety and success of GI endoscopy in children, including how to set up a pediatric endoscopy unit, how to train and assess pediatric endoscopy specialists, how to properly obtain informed consent for procedures in children, and how to measure the quality of endoscopic procedures, so critical in the current era. The emphasis in children’s endoscopy is different than in much of adult gastroenterology: much less relating to cancer and much more relating to congenital abnormalities, inflammatory diseases, and allergic diseases. A good example in this issue of a particular problem in young children is the proper management of button battery ingestion, a situation uncommon in adults, which requires specific understanding and is seen as a paradigm for management of severe pediatric foreign body ingestion. Endoscopic placement of gastrostomy feeding tubes can be essential, allowing continued growth and development in seriously ill young patients. It is common for certain pediatric GI diseases to continue into adult life, and adult gastroenterologists should be interested in topics covered in this issue: eosinophilic esophagitis and small bowel imaging in celiac disease and inflammatory bowel disease.

From a personal perspective, this is an extraordinarily special issue of the Gastrointestinal Endoscopy Clinics of North America . You might blink a few times when you see the cover, since the name Lightdale appears twice. You are not seeing double. There was no doubt in my mind that my daughter, Dr Jenifer R. Lightdale, should be the editor of this issue. Much to my delight, she has become a widely recognized leader in the field of pediatric endoscopy and has selected the topics and the outstanding authors for this remarkable issue. I believe there was a critical tipping point during her pediatric residency, when I invited her to accompany me on a trip to Japan. There, we had the opportunity to witness the actual hand manufacture of endoscopes and some spectacular new endoscopic procedures. It wasn’t long after that trip when Jen amazed me by joining a fellowship program in pediatric gastroenterology, and she continues to amaze me at all she has accomplished and continues to do. Every pediatric gastroenterologist should read this timely issue. Needless to say, it has my strongest recommendation for everyone interested in the field.

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