# Pediatric Endoscopy, Update 2020
## 2 What is Different in Pediatric Endoscopy
### Endoscope  
Special pediatric endoscopes with a diameter of less than 6 mm are commercially available from different companies and should be primarily used in children less than 10 kg body weight or younger than 1 year. The colon of a newborn is approximately 60 cm long. Recently the current available endoscopic material for pediatric endoscopy was published [17; 23].  
The problem of the very small endoscopes is the small working channel of \(<\)2 mm. The small channel is limiting the versatility of the endoscopes especially in its suction function and for instruments bigger than 1.8 mm. However, special pediatric forceps are available for histologic investigations, but the branches of the forceps are also limiting the size of the specimen (Table 1). Even in children of less than a year or less than 10 kg weight, standard endoscopes can be considered if endotherapy is required. It is advisable to use a standard gastroscope for colonoscopy as well until the age of 10, because in nearly all cases, the caecum can be reached with a standard gastroscope. A special pediatric colonoscopy is not necessary but can make the procedure easier in the age range of 5 to 12. The nasal endoscope can be used in newborns to avoid trauma. There are experiences with ultra slim colonoscopy as well. It is already used as a rescue in situations where standard colonoscopies have failed [24]. Endoscopic ultrasound is seldom performed in children because in almost all cases there are excellent percutaneous ultrasound conditions. If necessary, there is a special longitudinal diagnostic Pentax probe with an instrument diameter comparable to a standard gastroscope. Newborns can be easily investigated with help of an endbornchial endoscopic ultrasound probe [25; 26; 27; 28; 29; 30; 31].  
ERCP is rarely indicated. If necessary, a 7.5 mm duodenoscope should be used in children under the age of 1 year or weighing less than 10 kg. In elder children the therapeutic duodenoscope with 4.2 mm working channel can be taken for ERCP (ESGE guidelines) [14; 16; 32; 33; 34].  
The standard adult colonoscope has a diameter from 11.7 to 13.0 mm and can be used in teenagers. It is useful to know that the colon in younger age tends to be mobile therefore loop forming of the colonoscope is very common. Children under sedation are easily examined in a supine position  
\begin{table}
\begin{tabular}{l} \hline
**Accessories** \\ \hline Small biopsy forceps \\ Polyp snare \\ Small alligator forceps \\ Small injection needle \\ Small argon plasma coagulation probe \\
2-prong grasper \\ Pediatric Roth net \\ \hline \end{tabular}
\end{table}
Table 1: Accessories.  
with the legs slightly apart. The advancing end of the endoscope is often palpable or visible under trans-illumination through the thin abdominal wall of the child. Special attention should be given to the resolving of those loops because of the risk of perforation. The use of scope-guide is advisable; this technology works without X-ray but exploits magnetic pulses generated from the movement of electromagnetic coils incorporated along the shaft of the colonoscope in a low-intensity magnetic field. The precise position and orientation of the colonoscope within the colon can be displayed as three-dimensional image on a monitor. This information is extremely helpful to avoid loop formation and can guide supporting external pressure or loop solving.