325 - Feasibility of Unsedated Transpacifier-Assisted Upper Endoscopy in Neonates: A Proof-of-Concept Pilot Study

Publication Number: 325.5038

Jonathan A. Berken, The Children's Hospital of Philadelphia, Philadelphia, PA, United States; Jonathan A. Berken, The Children's Hospital of Philadelphia, Philadelphia, PA, United States; Zoe Rosoff-Verbit, Childrens Hospital of Philadelphia, Glenside, PA, United States; Elizabeth Silvestro, Children's Hospital of Philadelphia, philadelphia, PA, United States; Michael A. Manfredi, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Matthew J. Ryan, Children's Hospital of Philadelphia, Philadelphia, PA, United States

Background: Infants often require esophagogastroduodenoscopy (EGD) for diagnosing upper gastrointestinal disorders. Standard EGD involves general anesthesia, which increases costs, procedure time, and risks to brain development. Thus, anesthesia-free alternatives are highly desirable.

Objective: This study investigated the feasibility of a novel unsedated transpacifier upper endoscopy (TPE) in infants ≤ 6 months of age. The primary objectives were to assess procedural success, biopsy adequacy, patient stability, and parent and physician attitudes toward TPE versus standard EGD.

Design/Methods: Infants under 6 months of age with intact suck reflex, receiving care as either inpatients or outpatients at the Children’s Hospital of Philadelphia (CHOP), were included. Exclusion criteria comprised mechanical ventilation, epilepsy, hemodynamic instability, suspected gastrointestinal bleeding, or need for therapeutic EGD. Eligible infants were identified through gastrointestinal consultation.

TPE was performed using a 3.1 mm bronchoscope passed through a modified pacifier flavored with Sweet-ease, a sucrose-water solution for mild analgesia. The pacifier, designed by CHOP’s 3D printing lab, was secured in place, and no anesthesia was used. Vital signs were monitored throughout the procedure and the Neonatal Infant Pain Scale (NIPS) and potential adverse events were assessed. Caregivers shared their attitudes toward TPE, while gastroenterologists provided feedback on clinical applicability.

Results: TPE was successfully performed on a 3-month-old infant. She remained hemodynamically stable throughout the procedure, with no significant fluctuations in vital signs. Biopsy samples were adequate for pathology analysis. Feedback from gastroenterologists indicated high satisfaction with the procedure, while the parent attitude was positive, especially regarding the avoidance of anesthesia. Nursing documentation of the NIPS score indicated that the infant tolerated the procedure.

Conclusion(s): Our findings indicate that TPE may offer a safe and effective alternative to traditional EGD. The procedure was well-tolerated, yielded high-quality biopsy samples, and received positive feedback from both parents and physicians. These results underscore TPE's potential to reduce healthcare costs and provide an anesthesia-free option for infants needing endoscopy. Future directions will focus on expanding this research to larger cohorts of at least 10 infants to further validate these outcomes.

Jonathan Berken Resume
Jonathan Berken_CV_PAS.pdf