Pediatric Endoscopy and High-risk Patients: A Clinical Report From the NASPGHAN Endoscopy Committee

UMMS Affiliation

Division of Pediatric Gastroenterology and Nutrition, Department of Pediatrics

Publication Date


Document Type



Analytical, Diagnostic and Therapeutic Techniques and Equipment | Digestive System Diseases | Gastroenterology | Health Services Administration | Pediatrics


Pediatric gastrointestinal endoscopy has been established as safe and effective for diagnosis and management of many pediatric gastrointestinal diseases. Nevertheless, certain patient and procedure factors should be recognized that increase the risk of intra- and/or postprocedural adverse events (AEs). AEs associated with endoscopic procedures can broadly be categorized as involving sedation-related physiological changes, bleeding, perforation, and infection. Factors which may increase patient risk for such AEs include but are not limited to, cardiopulmonary diseases, anatomical airway or craniofacial abnormalities, compromised intestinal luminal wall integrity, coagulopathies, and compromised immune systems. Examples of high-risk patients include patients with congenital heart disease, craniofacial abnormalities, connective tissues diseases, inflammatory bowel disease, and children undergoing treatment for cancer. This clinical report is intended to help guide clinicians stratify patient risks and employ clinical practices that may minimize AEs during and after endoscopy. These include use of CO2 insufflation, endoscopic techniques for maneuvers such as biopsies, and endoscope loop-reduction to mitigate the risk of such complications such as bleeding and intestinal perforation. Endoscopic infection risk and guidance regarding periprocedural antibiotics are also discussed.


adverse events, bleeding, endoscopy, pediatric

DOI of Published Version



Lightdale JR, Liu QY, Sahn B, Troendle DM, Thomson M, Fishman DS; NASPGHAN Endoscopy and Procedures Committee. Pediatric Endoscopy and High-risk Patients: A Clinical Report From the NASPGHAN Endoscopy Committee. J Pediatr Gastroenterol Nutr. 2019 Apr;68(4):595-606. doi: 10.1097/MPG.0000000000002277. PMID: 30664560. Link to article on publisher's site

Journal/Book/Conference Title

Journal of pediatric gastroenterology and nutrition

Related Resources

Link to Article in PubMed

PubMed ID