Pediatric Gastroenterology Advances


Advances in Pediatric Gastroenterology & GI Surgery

Advancing Therapeutic Endoscopy for Pediatric Inflammatory Bowel Disease

With one of the few pediatric gastroenterologists in the country trained in performing advanced endoscopic interventions for the treatment of pediatric inflammatory bowel disease, NewYork-Presbyterian Morgan Stanley Children’s Hospital is leading efforts to increase access to the latest therapeutics for children.

While great strides have been made in endoscopy for diagnostic and therapeutic applications for IBD in the adult population, the transition to the use of endoscopic interventions in children has been slow to keep pace. This is due, in part, to a paucity of formal training programs in advanced pediatric GI interventions, as well as the absence of tools and devices designed for the pediatric population.

image of Dr. Felice Schnoll-Sussman

Dr. Joseph Picoraro

image of Dr. Fa Kastrinos

Dr. Bo Shen

Bo Shen, MD, Director of the Inflammatory Bowel Disease Center at NewYork-Presbyterian/Columbia University Irving Medical Center, is a distinguished gastroenterologist recognized worldwide as the preeminent expert in pouch disorders and pouchitis, as well as in interventional IBD. As Vice Chair for Innovation in Medicine and Surgery and a Professor of Medicine (in Surgery) at Columbia, Dr. Shen continues to make inroads in therapeutic interventions for adults, and more recently, for children.

Joseph A. Picoraro, MD, is Associate Director of the Pediatric IBD Center at Columbia and Director of Pediatric GI Inpatient Services at NewYork-Presbyterian Morgan Stanley Children’s Hospital. In his goal to further the treatment for children with IBD, undertaking a training collaboration in interventional endoscopy with Dr. Shen was a natural progression. The combination of Dr. Shen’s expertise in interventional endoscopy and Dr. Picoraro’s skills in the pediatric arena and his knowledge of pediatric anatomy resulted in an expansion of the therapies that can be offered to children with Crohn’s disease and ulcerative colitis.

The Pediatric IBD Program at NewYork-Presbyterian Morgan Stanley Children’s Hospital provides family-centered care for children of all ages with Crohn’s disease and ulcerative colitis, including the most complex cases. The integrative, collaborative team of specialists offers a range of treatments, including novel medical therapies, nutritional interventions, advanced therapeutic endoscopy, and surgery.

The combination of Dr. Shen’s expertise in interventional endoscopy and Dr. Picoraro’s skills in the pediatric arena has resulted in an expansion of the therapies that can be offered to children with Crohn’s disease and ulcerative colitis.

“Dr. Shen identifies opportunities for endoscopic interventions to address complications that would formerly require surgery,” says Dr. Picoraro. “We have the capacity to care for children with IBD using the spectrum of therapeutics – from the newest medications and nutritional support to endoscopy and surgery. An important consideration related to performing endoscopy interventions in children is their size, which then determines the selection of endoscopes and the form of sedation that should be used in the procedure.”

image of Endoscopic IT knife therapy

Endoscopic IT knife therapy in a pediatric patient (Courtesy of Dr. Picoraro)

“If we can treat IBD medically, that is our goal,” says Dr. Picoraro. “However, surgery is still recommended for many patients, and we are now using the more minimally invasive endoscopic approach more frequently. As one example, we might select an endoscopic procedure for a child with progressive Crohn’s disease who has inflammation and stricture formation, which allows us to offer a less invasive technique to safely open the strictures.”

image of Dr. Neal LeLeiko

Dr. Neal LeLeiko

“Dr. Picoraro’s expertise in interventional endoscopy for children with IBD represents a unique and important niche for our IBD program,” says Neal S. LeLeiko, MD, PhD, Director of the Pediatric IBD Program at NewYork-Presbyterian Morgan Stanley Children’s Hospital. “These newer techniques enable us to avoid or delay surgery and maintain a child’s quality of life.”

The 40-year career of Dr. LeLeiko, who is board certified in pediatric gastroenterology and has a PhD in nutrition – a rare combination, has positioned him as a world-renowned authority on the role of nutritional therapy as a component of treatment for children and adolescents with IBD and other digestive disorders. “For some patients with IBD, nutrition may be a suitable treatment, but not for all, although parents frequently pursue this approach for their child,” says Dr. LeLeiko. “The most effective strategy is a healthy diet that eliminates as many additives as possible without risk of causing vitamin and mineral deficiencies.”

Read More

The Role of Diet, Nutrition, and Exercise in Preventing Disease. LeLeiko NS, Dorfzaun S, Picoraro J. Pediatrics in Review. 2022 Jun 1;43(6):298-308.

Emulsifiers and Intestinal Health: An Introduction. Richey Levine A, Picoraro JA, Dorfzaun S, LeLeiko NS. Journal of Pediatric Gastroenterology and Nutrition. 2022 Mar 1;74(3):314-319.

Shen B, Kochhar G, Navaneethan U, Cross R, Farraye FA, Iacucci M, Schwartz DA, Gonzalez-Lama Y, Schairer J, Kiran RP, Kotze PG, Kobayashi T, Bortlik M, Liu X, Levy A, Suárez BG, Tang SJ, Coelho-Praobhu N, Lukas M, Bruining DH, El-Hachem S, Charles R, Chen Y, Sood A, Mao R, Loras C, Dulai PS, Picoraro JA, Chiorean M, Lukas M, Shergill A, Silverberg MS, Sandborn WJ, Bernstein CN. Endoscopic Evaluation of Surgically Altered Bowel in Inflammatory Bowel Disease: Consensus Guideline from the Global Interventional IBD Group.The Lancet Gastroenterology & Hepatology. 2021 Apr 16;S2468-1253(20)30394-0.

Shen B, Kochhar G, Rubin DT, Kane S, Navaneethan U, Bernstein CN, Cross RK, Sugita A, Schairer J, Kiran RP, Fleshner P, McCormick JT, D'Hoore A, Shah SA, Farraye FA, Kariv R, Liu X, Rosh J, Chang S, Scherl E, Schwartz DA, Kotze PG, Bruining DH, Philpott J, Abraham B, Segal J, Sedano R, Kayal M, Bentley-Hibbert S, Tarabar D, El-Hachem S, Sehgal P, Picoraro JA, Vermeire S, Sandborn WJ, Silverberg MS, Pardi DS. Treatment of pouchitis, Crohn’s disease, and cuffitis and other inflammatory disorders of the pouch: consensus guidelines from the International Ileal Pouch Consortium. The Lancet Gastroenterology & Hepatology. 2022;7(1):69-95. doi: 10.1016/S2468-1253(21)00214-4.

For More Information

Dr. Joseph Picoraro

Dr. Neal LeLeiko


Advances in Pediatrics

Read more about our latest clinical advances.