Safety and Ethics in Endoscopic Studies in Children: Evidence From the BEECH Study in Zambia
| Autor: | Miyoba Chipunza, Kanta Chandwe, Beatrice Amadi, Paul Kelly, Masuzyo Zyambo |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Pediatrics
medicine.medical_specialty Malabsorption Sedation Biopsy MEDLINE Zambia 03 medical and health sciences 0302 clinical medicine medicine Fagus Humans 030212 general & internal medicine Adverse effect Child Growth Disorders Original Paper Environmental enteropathy medicine.diagnostic_test business.industry medicine.disease Endoscopy Infectious Diseases Child Preschool Pediatrics Perinatology and Child Health 030211 gastroenterology & hepatology Intestinal Disorder medicine.symptom business AcademicSubjects/MED00670 Biomarkers |
| Zdroj: | Journal of Tropical Pediatrics |
| ISSN: | 1465-3664 0142-6338 |
| Popis: | Background Environmental enteropathy is an example of a poorly-understood intestinal disorder affecting millions of children worldwide, characterized by malabsorption and stunting. Although there is increasing interest in non-invasive means of assessing intestinal structure and function, the potential value of intestinal biopsy for histology, immunostaining, RNA sequencing and epigenetic work means that endoscopic biopsy remains extremely valuable. We here report our experience in the BEECH (Biomarkers of Environmental Enteropathy in CHildren) study of stunting in Zambia, in the belief that it may help address the knowledge gap regarding the safety of endoscopic biopsy in vulnerable young children. Methods We report our experience of safety in 119 children undergoing endoscopic biopsy in the BEECH study in Lusaka Children’s Hospital, Lusaka, and discuss ethical considerations in this light. Results Upper gastrointestinal endoscopy was performed on children with stunting (length-for-age z score -2 or less) not responsive to nutritional interventions. Conscious sedation was provided by anaesthetists. Of 119 children, 5 (4%) developed transient desaturation, but no serious adverse events were experienced; no clinical, demographic or anaesthetic characteristics were identified as predictive of desaturation. Two children derived clinically useful information from the endoscopy, one life-saving. Of 105 lactase tests, 59 (54%) showed hypolactasia. Discussion Children with stunting underwent endoscopy safely, and some derived clinical benefit. Safety and the possibility of clinical benefit are usually felt to be preconditions for the ethical justification for endoscopy for research in children, and we believe that these conditions were met in this study. |
| Databáze: | OpenAIRE |
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