小児科医・小児外科医と消化器内視鏡医との連携

Collaboration between pediatricians, pediatric surgeons, and digestive endoscopists

要旨

小児の消化器内視鏡診療の機会が増えている。施設により内視鏡経験の豊富な小児科医・小児外科医である小児内視鏡医を中心に内視鏡診療を実施する場合と，成人診療科医である消化器内視鏡医を中心に小児診療科と連携して実施する場合などさまざまである。小児専門施設である当院では，小児内視鏡医が通常観察や基本的な内視鏡治療を実施するが，小腸バルーン内視鏡やERCP・EUSなどは手技に熟練した消化器内視鏡医との連携が不可欠である。消化器内視鏡医の常勤がいない小児専門施設の課題として，各種内視鏡スコープや処置具は常備していないことがあり，消化器内視鏡医がスコープや処置具を持参して出張する場合と，消化器内視鏡医の常勤施設に患者が転院して検査・処置をする場合があり，患者の状態やリスクを考慮して選択する。今後も多様化が予想される小児内視鏡診療では，小児科医・小児外科医と消化器内視鏡医との連携がより一層重要であると考える。

　Opportunities of pediatric gastrointestinal endoscopic examination and treatment are increasing. Depending on the institution, pediatric gastrointestinal endoscopy is performed by different staff members such as pediatric endoscopists, who are pediatricians or pediatric surgeons with extensive experience in endoscopy, or gastrointestinal endoscopists in collaboration with the pediatric department. At our pediatric clinic, pediatric endoscopists perform routine observation and basic endoscopic treatment, but collaboration with a skilled gastrointestinal endoscopist is essential in procedures such as balloon-assisted enteroscopy, ERCP, and EUS. In many pediatric facilities that do not have a full-time gastrointestinal endoscopist, various endoscopic scopes and instruments are not always available, and choices are made based on the patient’s condition and the risks involved between asking a gastrointestinal endoscopist to visit with necessary scopes and instruments and transferring the patient to a facility with a full-time gastrointestinal endoscopist for examination and treatment. In pediatric endoscopic care, which is expected to diversify in the future, collaboration between pediatricians, pediatric surgeons, and digestive endoscopists will become even more important.