Biomedical subjects
Paul H Parker
Publications and source records attributed to Paul H Parker.
Unsedated upper endoscopy in children.
BACKGROUND: EGD is essential to the investigation and treatment of GI disorders in children. Although safe, EGD has the potential for complications, in particular cardiopulmonary abnormalities associated with intravenous sedation. EGD is often performed in adults without sedation. Unsedated EGD is occasionally performed in children but has not been subjected to study. This study assessed the safety, efficacy, and feasibility of unsedated EGD in children. METHODS: Selected, highly motivated children requiring EGD were offered the choice of sedation or no sedation for the procedure. Children recorded scores for pain (face scale) and anxiety (vertical visual analogue scale) before and after EGD. In addition, the times required to prepare the patient, perform the EGD, and recover the patient were recorded. RESULTS: There was no difference in age, gender, or pre-EGD pain scores between children selecting sedation or no sedation. However, children selecting sedation had significantly higher pre-EGD anxiety scores than those who chose no sedation. Successful completion of EGD was similar for sedated (96.3%) and unsedated (95.2%) children. Post-EGD scores for anxiety were significantly decreased in those receiving sedation and unchanged in children who received no sedation. There was no significant change in post-EGD pain score in either group. Nearly 80% of children undergoing unsedated EGD would elect to forego sedation if EGD was needed again. Total procedure time was significantly longer in sedated versus unsedated children, reflecting longer preparation and recovery. CONCLUSIONS: Unsedated EGD can be performed safely and successfully in children with good patient tolerance. There was a significant decrease in total procedure time for children who have unsedated EGD. Unsedated EGD should be considered a viable option for motivated children.
The inflammatory polyp-fold complex in children.
The inflammatory polyp-fold complex (IPFC) is an uncommon endoscopic or radiologic finding in children. In this complex, an inflammatory polyp at the gastroesophageal junction is present, often in continuity with a prominent gastric fold. Histologically, there is an inflammatory infiltrate in otherwise benign gastric and esophageal mucosa. We report four cases of IPFC in children, all associated with reflux esophagitis. In two patients who underwent repeat endoscopy, acid suppression therapy led to a decrease in the size of the polyp and histologic improvement of esophagitis. Four case studies in children with IPFC are presented, followed by a literature review of this endoscopic finding as it applies to children.
Bullous pemphigoid complicating Crohn's disease in a child.
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