REVIEW article
Front. Pediatr.
Sec. Pediatric Gastroenterology, Hepatology and Nutrition
Volume 13 - 2025 | doi: 10.3389/fped.2025.1630157
This article is part of the Research TopicPediatric Gastroenterology And Visualizing The Digestive TractView all 3 articles
The Mouth or the Nose: The Past, Present, and Future of Ultra-Slim Gastroscopy of the Upper Gastrointestinal Tract in Pediatrics
Provisionally accepted
- 1Phoenix Children's Hospital, Phoenix, United States
- 2The Medical College of Wisconsin, Milwaukee, United States
- 3Columbia University Medical Center, New York, United States
- 4Children's Hospital of Philadelphia, Philadelphia, United States
- 5EvoEndo Inc, Grayslake, United States
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Background: Ultra-slim, flexible endoscopy pioneered for the evaluation of luminal diseases of the airway, has been used for over 40 years. In the late 20th century, it was adopted in the gastrointestinal specialties for evaluation of the digestive tract with and without the need for sedation. Since the advent of this technology, numerous descriptions of its use in small anatomic areas have been described. These include stricture evaluation and therapy, ostomy evaluation, biliary interventions, and diagnostic endoscopic evaluation of pediatric patients. This manuscript reviews the availability and clinical utility of ultra-slim flexible endoscopes, describes technical approaches, and highlights the potential value the technology offers to pediatric providers and healthcare systems. Methods: A comprehensive literature review was conducted on the use of ultra-slim endoscopes in the pediatric and adult gastroenterology. Expert discussions were held to evaluate current practices, indications, and equipment. The resulting expert opinion was generated to summarize pertinent information regarding key techniques, indications, and practical considerations for implementation in pediatric settings. Results: Although ultra-slim endoscopes started their use in small-space adult gastroenterology procedures, they have shown significant benefit and value within pediatrics. The literature documents their use in both sedated and unsedated environments, including transnasal upper endoscopy, variceal surveillance, esophageal stricture evaluation, neonatal endoscopy, enteral tube placement, and ostomy assessment. Conclusion: Ultra-slim flexible endoscopy provides pediatric gastroenterologists with a valuable diagnostic and therapeutic tool. When used appropriately, either with or without sedation, it has the potential to increase clinical efficiency, reduce procedural risk, and improve access to care.
Keywords: Pediatrics, Gastroenterology, Ultra-slim, ultrathin, Endoscopy, transnasal endoscopy, virtual reality, Esophageal stricture
Received: 17 May 2025; Accepted: 04 Jul 2025.
Copyright: © 2025 Tran, Lee, Mencin, Ryan, Friedlander and Manfredi. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Paul Tran, Phoenix Children's Hospital, Phoenix, United States
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.