Practical Pediatric Gastrointestinal Endoscopy

Endoscopy in the modern world in children could not occur ‐ especially endo‐therapeutic ‐ without the excellence of our anaesthetists ‐ my stars are Dr David Turnbull, Dr Liz Allison, Dr Kate Wilson, Dr Rob Hearn, Dr George Colley at the Royal Free, and most importantly of all, the best paediatric anesthetist of them all, Dr Adrian Lloyd‐Thomas (AL‐T). A quick story ‐ the modern practice of topical application of Mitomycin C after esophageal dilation came from a chance conversation with AL‐T, who told me that the ENT guys used Mitomycin C post‐laryngeal reconstruction to prevent circumferential stenosis ‐ we tried it and it worked in the esophagus of a girl requiring multiple frequent esophageal dilation. Cue a paper in The Lancet. Perhaps we should have more cross‐specialty conversations?

We should remember that this is the only truly ‘procedure‐specific’ paediatric specialty and stick to our guns with respect of the importance of endoscopy in our training. The Guidelines and Position Papers, some joint with ESGE and NASPGHN have been extremely well received and, in addition, have helped in raising the JPGN Impact Factor to its new dizzying height of nearly 3.

Medicine is a vocation amongst us of course, and training the next generation has been one of my major aims. In this I am particularly grateful to Prof Sanja Kolacek in her unswerving support and application of her considerable energy in moving forward the recent amazing ESPGHAN Endoscopy Fellowship Program ‐ worth mentioning again!

We should, in my view, never compromise on the quality of training or care delivery afforded by paediatric endoscopy by those of us fortunate enough to have benefitted by it in our careers. Adult GI endoscopists should be involved only if we cannot avoid it ‐ that comes down to our learning the correct skills and techniques and making their involvement redundant. We still have plenty to learn from them though, I will acknowledge.

Recently we have created a global community for Pediatric Endoscopy ‐ adult GI, European, North American, South American, Asian, Australasian Peds GI ‐ and Joint Endoscopy Guidelines have emerged – this is fantastic and I am sure that this fruitful collaboration will continue. Special mention should go to the drivers of these collaborative efforts and the contributors ‐ Catharine Walsh, Doug Fishman, Jenifer Lightdale, Jorge Amil‐Dias, Andrea Tringali, Mario Vieira, Raoul Furlano, Victor Fox, Looi Ee, Patrick Bontems, Matjaz Homan, Rok Orel, Frederick Gottrand, Alexandra Papadopoulou, Salvatore Oliva, Erasmo Miele, Claudio Romano, Luigi Dall’Oglio, Rob Kramer, Mike Manfredi, Diana Lerner, Marsha Kay, Tom Attard, Warren Hyer, Joel Freidlander, ‘The Richards’ Hansen and Russell, David Wilson, Dan Turner, Pete Gillett, Pat McKiernan, Stephen Murphy, Christos Tzivinikos, Ari Silbermintz, Rupert Hinds, Marta Tavares, Bruno Hauser, Yvan Vandenplas, Ron Bremner, Pete Lewindon, Petar Mamula, Orin Ledder, Merit Tabbers, Ilse Broekaert, Cesare Hassan, Marc Benninga, Alessandro Zambelli, Nikhil Thapar, Iva Hojsak, Stefan Husby, Ilektra Athiana, Andreia Nita, Sara Isoldi, Paola DeAngelis, Lissy De Ridder, the incomparable Samy Cadranel, all in the Sheffield Team and many many more ‐ apologies if I have missed you out!

Thank you to the numerous members of the endoscopy Companies that have been so helpful over the years with Courses etc etc. You will know who you are but to numerous to mention here.

Kevin and Kat in ESPGHAN Head Office have always been very receptive to any Qs needed and I am grateful to them.

There is no ceiling to what we can achieve in pediatric endoscopy. Attending ‘adult’ GI and endoscopy meetings is illuminating e.g. ‘ESGE Days’. We are no longer the Cinderella part of pediatric GI but we still need to achieve parity with the adult Societies ‐ a place at the ‘top table’ i.e. Societal Councils – as occurs in all adult GI Societies.

I would like to thank all the trainees from so many countries and backgrounds for their personal commitment and sacrifice over the last 25 years in coming to train with us ‐ it never ceases to amaze me how mothers and fathers and spouses can leave their loved ones for months, on occasions a year or more, in order to train in this fantastic compelling area. Their ability to do so has been facilitated by my amazing Endoscopy Fellow and Course Coordinator, without whom it would have been truly impossible to run such a successful training program ‐ Sam Goult. Thankyou Sam.And then, if you have got this far then ‘well done’. It is so important to me to hold up my hand and say that, in all honesty, I could have not done all that I have done (admittedly a microcosm in the great scheme of things) without the forbearance and tolerance of my wife Kay and my exceptional and talented and kind daughters Ella, Jess and Flo. Incredible people and my driving force. I am sorry to you all for being away so much giving lectures and all that stuff when you were growing up and when you, Kay, were managing them so amazingly, almost single‐handedly. I would have done things differently if I had had the time again and know what I know now. Medicine as a job is not necessarily life, although some times it is difficult to see beyond the vocation.

Lastly, I want to say a special thankyou to all the families and children that it has been my pleasure and privilege to help over the last 35 years.

As a small post‐script it would be remiss of me to not thank all the authors who have been extremely patient over the last 4 years and I hope that you will be happy with the labour of love that has produced this book with your extraordinary help. Nearly all of you are good friends – some are friends yet to make – some are friends during this process that have sadly passed. Gábor (Veres) was a great and a good man and I never saw him be anything but kind and intelligent and helpful and energetic. A particularly sad event occurred recently – Prof Samy Cadranel lost his battle against cancer. He trained and touched so many in our discipline from the late 1970s to the modern day. He was a real giant in the field of pediatric endoscopy – he produced the first bespoke pediatric endoscope in 1978, led the field in diagnostics and then in therapeutic endoscopy. He trained a generation across the world leaders in the field such as Carlo di Lorenzo, Luigi Dall’Oglio and many many others. I was asked by him to lecture on advances in endoscopy at his Festschrift in Brussels some 15 years ago – he may have retired but he maintained a phenomenally active role in ESGPHAN. Most recently he taught on our Endoscopy Learning Zone at the Annual ESPGHAN Meeting and was always there for me if I needed a bit of guidance or advice. What he did not know about pediatric endoscopy is not worth knowing. A polymath and a multi‐linguist, but above all a really nice man and a wise and good doctor. We will miss both of these guys greatly in the future.

Please enjoy this text if you can, and believe me when I say that this is the distillation of a life’s work, but not just mine ‐ it is a distillation of all that I have been taught and that George has been taught ‐ it is therefore the ‘handing down of knowledge’ which is key to keeping a discipline moving forwards.

YOU! – the next generation – continue to push paediatric endoscopy forwards – training, research, Courses, expansion of the ELZ, further collaboration with our friends all over the world and push for live endoscopy at all the annual meetings – but please remember that, like our counterparts in adult GI endoscopy, we should be recognized and have a say on the Councils of our respective Societies.

Can I just mention some amazing people that deserve it who have been mentioned and some who have not? Andrei Nita; Jorge Amil‐Dias; Alexandra Papadopoulos; Marc Benninga; Nikhil Thapar; Pete Lewindon; Tom Attard; Warren Hyer; Muftah Eltumi; Paul Hurlstone; Mark Donnelly; Mark McAlindon; Stuart Riley; Deb Salvin (of the world‐famous ‘Salvin procedure’); Dom Hughes; Helen Wigmore; Ben Roebuck, Jamie Shepherd; Dave Turnbull; Liz Allison; and of course all the extremely patient authors of all the Chapters.