Practical Pediatric Gastrointestinal Endoscopy

The next ten years were eye‐opening. The ‘dream‐team’ of JAWS (which acronym I know he dislikes), Simon Murch, Alan Phillips, me and latterly Rob Heuschkel were as close to a medical family as is possible. We should remember here our friend Dave Casson who sadly passed away from gastric cancer. Importantly I was privileged to learn at John’s feet but almost, if not more, significant for me, I was able to hone my apprentice‐type ileo‐colonoscopy skills with the greatest of them all, Prof Christopher Williams. A unique character is a fair way to describe him, but he is acknowledged as having been the best of the best when it came to ileo‐colonoscopy training. Simon Murch, John Fell and I learnt a great deal. We were in the mid‐nineties, however, still iv drug users! Eric Hassall, the famous North American paediatric gastroenterologist and a good and wise friend, once wrote a paper ‘Why pediatric endoscopists should not be iv drug users.’ Referring to the dual role of performing a procedure and also administering the iv sedation. Holding down a child should never be part of an endoscopy, nor should respiratory rescue. ‘Let the anaesthetists do what they want to keep the child still, unknowing and amnesic and don’t get involved’ has always been my mantra. Cost and availability of anaesthetists is the only reason why it still happens in the bad old way.

So I had a vision ‐ please forgive me for sounding like a prima donna! The John Walker‐Smith Unit had been running a brilliant Paeds Gastro Course in December in London for at least 12 years. As the young guy and the endoscopy enthusiast I thought ‘why not add on a live endoscopy day?’ John was very receptive and the first one was a real experiment but it worked. I still owe Simon an apology for training the room camera on him as he was scoping and videoing his ‘gurnying’ (facial movements as if in pain), during a live ileo‐colonoscopy, to 150 people in the main auditorium! Fortunately, he has a great and forgiving sense of humour. It was probably the first ever successful live paediatric endoscopy meeting. The close interaction with scientists such as Alan Phillips also came out in this Course with biopsy orientation and handling adding another dimension. The Meeting seemed, apparently, to work smoothly ‐ but a bit like a swan gliding serenely over the lake’s surface, meanwhile its legs swimming frenetically beneath, we were frantically trying to get all the pieces of the jigsaw to fit together and at the appropriate time. It was amazing and a real privilege to be able to invite the great and good from the world of paediatric endoscopy over to London to teach over the next 10 years ‐ Victor Fox, Luigi Dall’Oglio, Jean‐Francois Mougenot, Jean‐Pierre Olives, Sami Cadranel, Yvan Vandenplas, Ernie Seidman, Harland Winter, Athos Bousvaros, Raoul Furlano and of course Eric Hassall. Other giants of the field I was to meet later.

Over the next ten years we worked closely with the adult GI Unit and Prof Owen Epstein and I produced a DVD with over 400 endoscopy videos and stills, which is still available and remains for me a great resource for Powerpoint presentations etc. This textbook has many other videos on the accompanying webpage if you are interested. The Paediatric Endoscopy Unit evolved and we started pioneering therapeutic techniques with close clinical governance, and always learning from meetings such as the BSG, ESGE, UEGW, and DDW which showcased new and exciting techniques in endo‐therapy. The Unit did however produce a non‐endoscopy virtue ‐ a wife and our first daughter ‐ Kay was a part of our team at middle grade level for a while which is how we met (Mills and Boon or not!) and I remain so grateful that she threw her towel in with me!

Eventually the ‘pull to the North’ became overwhelming for me ‐ back to where I grew up ‐ and in 2004 I took the difficult and painful decision to leave John, Alan, Simon and Rob and move to the relative peds GI virgin territory of Sheffield Children’s Hospital. Back to ‘God’s Own County’, Yorkshire. Thanks to Kay, my incredible and long‐suffering partner for agreeing and sacrificing her promising career in ‘Pharma’ to which she had made a transfer and a name for herself in a short time. I appreciate it more than you can know.

So, now a blank canvas ‐ almost. Prof Chris Taylor was the only paeds GI there when I arrived on, fittingly, April the 1st 2005. I remember that in the very first list I broke their only colonoscope! Oops! Time to get some more then. . . . . . .

Chris was a very generous host and indulged my ambitions. He was even kind enough as we became friends to ask me to be his best man and I was delighted ‐ only embarrassing him slightly.

In 2005 we carried on with the Royal Free Course but then transferred it to Sheffield the year after and converted it to a Hands‐On small group ileo‐colonoscopy Course over 2–3 days. This was to be the template for the nest 15 years and has increased in frequency driven by demand to about 6–8 a year.

Meanwhile we began to build the Unit and with my colleagues and friends we have now over 50 staff. Prof Chris Taylor and Prof Stuart Tanner (hepatology) retired (Chris only recently) and I was joined by consultant colleagues Sally Connolly (now also retired), David Campbell, Prithviraj Rao, Priya Narula, (temporarily Dalia Belsha, Franco Torrente and Camilla Salvestrini), Arun Urs, Natalia Nedelkopoulou, Shishu Sharma, Zuzana Londt, Intan Yeop and Akshay Kapoor. Amazing team who all bring something different to the table. The Gastro Nurses are so important to us led very ably by Valda Forbes. Dietitians also brilliant led by Lynn Hagin, SALT by Jane Shaw, and psychology by Charlotte Merriman are also hugely important and fantastic. Prof Marta Cohen, head of histopathology and I have collaborated on research over the years and she is always energetic and a great colleague to have.

The people of Sheffield and the region are, contrary to popular belief of a Yorkshireman being a ‘Scotsman robbed of his generosity’, incredibly generous. The Sheffield Children’s Hospital Charity (led by my friend David Vernon‐Edwards) were, and have been, pivotal in financial help to make the Unit the most fantastic place to work ‐ the Endoscopy Unit of the Future, the double balloon enteroscopy set up, the wireless capsule endoscopy service and the new magnetic‐controlled capsule technology, and most recently the Symbionix virtual endoscopy training simulator, are amongst a few of the things that they have kindly and generously funded for us, allowing us to stay at the cutting edge of training and diagnostic and endo‐therapeutic capability.

An area that I am particularly happy with is the ESPGHAN Council’s open‐minded approach to the Endoscopy Special Interest Group initiatives in terms of Training. Hands‐On Courses are spreading, the Endoscopy Learning Zone at the Annual Meeting has been fantastic and is going from strength to strength under the guidance now of Prof Raoul Furlano, and the first ever live endoscopy session occurred in 2019 in Glasgow at the Annual ESPGHAN Meeting and was very well received. There is nothing like performing live endoscopy to 500 people to get the cardiovascular system energised! Thank you to the recent Presidents of ESPGHAN Raanan Shamir and the ever‐enthusiastic Sanja Kolacek. Sanja has pushed for, and obtained funding for, the ESPGHAN Pediatric Endoscopy Fellowships which are starting in early 2021, which will be amazing ‐ thank you!

My endoscopic ‘raison d’être’ is to attempt to put the paediatric surgeons out of work! Hence pushing the boundaries in such areas as are covered in this Textbook. Nevertheless, I think it is critical that we work hand in hand with our surgical colleagues, many of who perform endoscopy, in order to blur the interface between our approaches. I am extremely fortunate to work with some fantastic and enlightened individuals in the surgical team and we are almost a joint Unit nowadays – as can be seen by our innovations with laparoscopic assisted endoscopic percutaneous jejunostomy and duodenal web division, amongst many others. Maybe I am a frustrated surgeon after all! Hopefully the web page is educational to those that access it with many videos etc. I am particularly indebted to the open‐minded attitude and team‐spirited nature of Mr Sean Marven, Mr Richard Lindley, Prof Ross Fisher, Mr Suresh Murthi, Prof Prasad Godbole, Ms Emma Parkinson, and more recently Ms Liz Gavens and Ms Caroline McDonald. Sparring with Jenny Walker was always fun and we are now good friends. Rang Shawis and Julian Roberts should not be missed out here.