| 特集名 | 緊急内視鏡の適応と実際 | |
|---|---|---|
| 題名 | 小児における緊急内視鏡の注意点 | |
| 発刊年月 | 2018年 05月 | |
| 著者 | 中山 佳子 | 信州大学医学部小児医学教室 |
| 【 要旨 】 | 小児の緊急内視鏡のおもな適応は，活動性消化管出血と異物誤飲である．小児の活動性消化管出血の原因は多様で，全身状態を安定させた後に出血源の同定と止血術が行われる．異物誤飲は，小児科医が対応に苦慮する訴えの一つである．緊急異物摘出術は，症状のある食道異物，すべての食道に滞留したボタン電池が良い適応とされる． 基本的な内視鏡操作や治療手技は，小児と成人で同様であるが，体が小さい乳児や幼児では細い機器を選択しなければならない．また，一般的に胃内容物の誤嚥もしくは不安定な呼吸循環動態のため，合併症のリスクが高くなる．重症例では気道の確保，呼吸循環の管理，体動がないという利点から全身麻酔が望ましい． |
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| Theme | Indications and Standards of Practice for Emergency Endoscopy | |
|---|---|---|
| Title | Emergency Endoscopy in Children | |
| Author | Yoshiko Nakayama | Department of Pediatrics, Shinshu University School of Medicine |
| [ Summary ] | In children, urgent endoscopy is primarily indicated in patients with active bleeding or foreign body ingestion. Acute gastrointestinal bleeding can occur from a variety of sources in pediatric patients. Endoscopic evaluation is performed, and several endoscopic techniques are used to achieve hemostasis after stabilization of the patient's condition. Foreign body ingestion is an extremely challenging clinical scenario faced by a pediatrician. Emergency foreign body removal in children is indicated in those presenting with any symptomatic esophageal foreign body and for asymptomatic children with button batteries in the esophagus. The technical aspects of performing an endoscopy and the therapeutic techniques are essentially similar between children and adults. The primary difference corresponds to the smaller size of all endoscopic equipment required to evaluate the smaller anatomical structures in infants and young children. Emergency endoscopy is associated with a higher risk of complications, which include the aspiration of gastric contents or decompensated cardiopulmonary function. In emergency situations, general anesthesia offers advantages to the endoscopist by providing close monitoring of the airways and cardiorespiratory function, as well as ensures patient immobility. |
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