Rene Esquivel Gomez, MD: Pediatric Endoscopy and Colonoscopy Strategies

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Slight differences in disease presentation, as well as navigating the safety discussion with parents, presents unique recommendations for pediatricians initiating invasive imaging.

In an interview with HCPLive during the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) 2023 Annual Meeting in San Diego, Rene D. Gomez-Esquivel, MD, assistant professor in the division of digestive diseases and nutrition at University of South Florida, discussed the specific role of endoscopies and colonoscopies for pediatric gastric disease.

“We do it to assess the degree of inflammation, the location of the inflammation, and to see the response of the therapy,” Gomez-Esquivel said. “One other area that is important to look for in patients that have had inflammatory bowel disease for several years is to look for pre-malignant or malignant conditions. So that's why we do the endoscopy.”

This utility is not much different, if at all, from adult patient uses.

“I think the patients with inflammatory bowel disease in pediatrics, they tend to have symptoms for more time, unless it's person with severe disease—but sometimes they present with vague symptoms that do not prompt the colonoscopy,” Gomez-Esquivel said. “And they might take more time to be found to have inflammatory bowel disease.”

It’s critical to emphasize the importance of colonoscopies to children and their parents alike.

“Fortunately, the the technology nowadays make both the sedation and the procedure itself to be very, very safe. These procedures are relatively quick; they take about 30 minutes or so. So, it's very quick and give us a lot of information.”

Recent trend data suggest a growing interest among adults to consider noninvasive alternatives to colonoscopies. When asked whether such alternatives are ideal or even viable for pediatric patients, Gomez-Esquivel said the same limitations exist as with adults.

“They don't help you to assess the actual mucosa the actual inside,” he said regarding the alternatives. “Colonoscopy is the only one that helps you to assess the mucosa specifically in inflammatory bowel disease. And this applies both to pediatric and adult patients. A lot of the lesions that they present when they're flat, they're very discreet, and they're very hard to see on a CT scan. And obviously, they're not going to be seen with the other test.”

There’s also the matter of clearer polyps detection through colonoscopy, and a reduced risk of pseudo polyps—which would then trigger the need for a colonoscopy anyway.

“Pediatric colon cancer is not as common as is in adults,” Gomez-Esquivel added. “There are only about 2.3% of the colon cancers in the country, so it's a very small population. So these tests were obviously not designed with this population in mind.”

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