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Diagnostic yield of EGD in children: a retrospective single-center study of 1000 cases
Melissa A Sheiko1, James A Feinstein, Kelley E Capocelli
1Department of Pediatrics, Children's Hospital Colorado, Aurora, CO 80045, USA.
Insights
Diagnostic yield of pediatric esophagogastroduodenoscopy (EGD) varies by indication and patient age. This study highlights how clinical symptoms influence the likelihood of finding significant endoscopic and histologic abnormalities in children undergoing EGD.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Endoscopy
- Clinical Outcomes Research
Background:
- Pediatric esophagogastroduodenoscopy (EGD) utilization is rising.
- Recent data on the diagnostic yield of pediatric EGD is limited.
Purpose of the Study:
- To evaluate the relationship between presenting symptoms and the probability of significant endoscopic and histologic findings.
- To inform the decision-making process for initial diagnostic endoscopy in children.
Main Methods:
- Retrospective cohort study of 1000 patients (1 month to 18 years) undergoing initial diagnostic EGD.
- Data collected from a large, tertiary care children's hospital between 2009 and 2010.
- Analysis focused on endoscopic and histologic abnormalities based on presenting indications.
Main Results:
- Common indications included abdominal pain (28.7%), reflux (11.7%), and failure to thrive (9.5%).
- Overall endoscopic abnormality rate was 34.7%, and histologic abnormality rate was 40.4%.
- Highest abnormality rates were associated with strictures, foreign bodies, GI bleeding, and celiac screening.
Conclusions:
- Endoscopic and histologic abnormality rates in pediatric EGD differ significantly based on age and indication.
- Findings suggest that clinical presentation should guide the decision for initial endoscopy.
- Consideration of anesthesia risks and adverse events is also crucial.
Background:
Pediatric EGD is increasingly being used, but few studies have recently evaluated the diagnostic yield.
Objective:
To assess the association between presenting clinical symptoms and the likelihood of significant endoscopic and histologic abnormalities for initial diagnostic endoscopy.
Design:
Retrospective cohort study.
Setting:
Large, tertiary care children's hospital.
Patients:
One thousand patients, ages 1 month to 18 years, who underwent initial diagnostic EGD in 2009 and 2010.
Interventions:
None.
Main Outcome Measures:
Endoscopic and histologic abnormalities.
Results:
The most common primary indications for endoscopy were generalized abdominal pain (28.7%), gastroesophageal reflux (11.7%), and failure to thrive (9.5%). The overall prevalence of an endoscopic abnormality was 34.7% and of a histologic abnormality, 40.4%. The highest rates of endoscopic abnormalities were found in patients with strictures on upper GI radiology (100%), foreign body (88%), and GI bleeding (57%). The highest rates of histologic abnormalities were in patients with positive celiac screening (91%), foreign body (88%), dysphagia (51%), and GI bleeding (49%), and the lowest rates of histologic abnormalities were miscellaneous indications (17%), strictures on radiology (25%), and reflux (26%). Females and patients < 1 year of age had lower rates of abnormal histologic abnormalities.
Limitations:
Retrospective nature of the study, limitation to a single tertiary care center, and simplification of complex patient presentations to a single indication.
Conclusions:
Rates of endoscopic and histologic abnormalities from EGD vary based on age and indication for endoscopy, and this should be factored into the decision to proceed with initial endoscopy along with consideration of adverse event rates and effects of anesthesia.
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