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Published on: January 17, 2011
Prospective peer-review audit of paediatric upper gastrointestinal endoscopy
Edward V O'Loughlin1, Shoma Dutt, Ramananda Kamath
1Department of Gastroenterology, The Children's Hospital at Westmead, Sydney, New South Wales, Australia. tedo@chw.edu.au
Insights
Peer-review audits reduced normal findings in paediatric upper gastrointestinal endoscopy (UGE), particularly for coeliac disease and recurrent abdominal pain syndrome (RAP). This strategy improved diagnostic yield in children undergoing UGE.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Endoscopy
- Quality Improvement in Healthcare
Background:
- Paediatric upper gastrointestinal endoscopy (UGE) is a common diagnostic tool.
- A significant proportion of UGE procedures in children yield normal findings, impacting diagnostic efficiency.
Purpose of the Study:
- To characterize findings from paediatric UGE.
- To implement and assess strategies for reducing the rate of normal findings in diagnostic UGE for children.
Main Methods:
- A 3-year study involving 1172 paediatric UGE procedures at a tertiary children's hospital.
- Endoscopic findings were compared to clinical diagnoses, with subgrouping by condition (e.g., recurrent abdominal pain syndrome, coeliac disease).
- A peer-review audit system was implemented after the first year to appraise endoscopists and reduce normal UGE rates.
Main Results:
- Overall, 48% of diagnostic UGEs were normal.
- Peer-review audit significantly decreased normal findings in coeliac disease (11%) and recurrent abdominal pain syndrome (RAP) cases.
- The reduction in normal findings was statistically significant (P < 0.01) for overall cases, coeliac disease, and RAP, but not for oesophagitis or enteropathy/inflammatory bowel disease investigations.
Conclusions:
- A substantial percentage of paediatric UGE procedures result in normal findings.
- Peer-review audit is an effective quality improvement strategy to reduce normal UGE rates, especially for diagnosing coeliac disease and managing recurrent abdominal pain syndrome in children.
Aim:
To describe the findings of paediatric upper gastrointestinal endoscopy (UGE) and to reduce the rate of normal findings in children undergoing diagnostic UGE.
Methods:
Upper gastrointestinal endoscopy were performed at a single tertiary referral children's hospital over a 3-year period by four endoscopists. Patients were subgrouped into diagnostic categories (recurrent abdominal pain syndrome (RAP), oesophagitis, coeliac disease and enteropathy/inflammatory bowel disease) and endoscopists recorded their clinical diagnosis as above before each procedure. Endoscopic and biopsy findings were compared with clinical diagnosis. After the first year of audit each endoscopist was appraised of their practice and strategies implemented to reduce the normal UGE. In years 2 and 3 all endoscopists were audited by their peers on a monthly basis.
Results:
A total of 1172 UGE were performed over a 3-year period. Ninety per cent were diagnostic procedures, of which 48% were normal, 16% identified oesophagitis, 11% coeliac disease, 6% gastritis, 3%Helicobacter pylori and 1% peptic ulcer disease. Peer-review audit significantly reduced the number of normal findings in coeliac disease, RAP and overall (P < 0.01) but not in the groups with presumed oesophagitis or investigation of enteropathy/inflammatory bowel disease.
Conclusions:
A high proportion of patients undergoing UGE have normal procedures. Peer-review audit can reduce the number of normal procedures particularly in RAP and in the diagnosis of coeliac disease.
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