Endoscopy Expertise at CHOP

Endoscopic procedures by expert hands are crucial in the diagnosis and treatment of children with gastrointestinal, liver, and pancreatic disorders. The Children’s Hospital of Philadelphia has one of the largest pediatric endoscopy centers in North America, performing more than 4,500 endoscopic procedures annually. The center’s staff, including approximately 90 physicians, nurses, technicians, and fellows, provides safe, innovative, and efficient care to patients — from infants to young adults — using common diagnostics such as colonoscopy and complex therapeutic procedures such as endoscopic retrograde cholangiopancreatography (ERCP).

“We pride ourselves on offering the most advanced procedures and technology and maintaining very high safety standards,” says the suite’s director, Petar Mamula, MD, an attending gastroenterologist at CHOP since 2001. “We’re also deeply committed to research to expand the options and improve care for children who undergo diagnostic and therapeutic procedures.”

Facts about CHOP's endoscopy suite

Here are some factors that help distinguish CHOP’s endoscopy suite, known as the Kohl’s GI Nutrition and Diagnostic Center:

• Motility expertise: The suite performs more than 350 motility procedures annually, including antroduodenal, anorectal, colonic, and esophageal manometry; biofeedback tests; wireless pH testing, and impedance/pH probe monitoring.
• Complex procedures and therapeutic interventions: Mamula, with colleagues at the Hospital of the University of Pennsylvania, offers ERCP, endoscopic ultrasound (EUS), and double-balloon enteroscopy. In addition to ERCP and EUS, the team offers a range of other therapeutic interventions including endoscopic mucosal resection, large polyp removal, treatment of gastrointestinal bleeding, stent placement, and stricture dilation.
• Wide range of standard procedures: The suite’s team provides endoscopy, colonoscopy, flexible sigmoidoscopy, single-balloon enteroscopy, livery biopsy, enema administration, nasogastric laxative cleanout, Botox® injection, hydrogen breath test, DXA, impedance/pH probe, paracentesis, infusion therapy (biologics and intravenous iron), and resting energy expenditure.
• Active research program: Mamula and team, including a dedicated endoscopy research fellow, are committed to improving care through research. They recently completed large reviews of the safety and effectiveness of ERCP and EUS in children, and are investigating other topics including safety of colonoscopy preparation; duodenal hematoma with esophagogastroduodenoscopy; and new dilatation strategies in esophageal achalasia. Under the leadership of another attending gastroenterologist at CHOP, Judith Kelsen, MD, the team also recently established a protocol for fecal microbiota transplant for recurrent C. difficile infection.
• Large, experienced staff: The staff includes 15 pediatric GI fellows, 11 advanced practice nurses, 25 registered nurses, and five GI technicians, as well as the 34 attending physicians in the Division of Gastroenterology, Hepatology and Nutrition at CHOP.

The suite has a unique configuration, with bays for sedation and infusion right across the hall from endoscopy services. It’s a set-up that works well for patients and families, as well as the staff. For example, patients with inflammatory bowel disease visit the same physical space and are served by the same staff whether they are coming in for endoscopy or infliximab infusions. “Our configuration, with sedation, infusions, and endoscopy grouped so closely, came about largely by accident, as the Hospital grew,” Mamula said. “But it’s a happy accident. We’ve found this proximity to be very beneficial to two of the things that are most important in providing the best care — staff communication and our ability to get to know patients and their families.”

Types of referrals

Here are a few examples of consultative requests Mamula and team receive from referring physicians:

• Small bowel polyp removal
• Evaluation of chronic or recurrent pancreatitis
• Treatment of a biliary stricture
• Endoscopic ultrasound for gastric, intestinal, and pancreatic lesions including hyperinsulinism
• Treatment of refractory strictures including stent placement
• Endoscopy post bariatric surgery
• Endoscopic esophageal myotomy (POEM)