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What is the diagnostic utility of endoscopic scoring systems in children?
Engin Tutar1, Günsel Kutluk, Nevzat Aykut Bayrak
1Departments of Pediatric Gastroenterology, Hepatology and Nutrition, Marmara University School of Medicine, İstanbul, Turkey.
Insights
Adult endoscopic scoring systems for esophagitis are not suitable for children. New methods are needed to accurately diagnose milder pediatric esophagitis based on endoscopic findings.
Area of Science:
- Pediatric Gastroenterology
- Endoscopy
- Histopathology
Background:
- Esophagitis classification systems are crucial for diagnosis and treatment.
- Existing systems like Savary-Miller, Hetzel-Dent, and Los Angeles were developed primarily for adults.
- Pediatric esophagitis may present differently than in adults, necessitating evaluation of current classification systems.
Purpose of the Study:
- To assess the inter-rater reliability of the Savary-Miller, Hetzel-Dent, and Los Angeles endoscopic classification systems in children.
- To compare the diagnostic consistency of these endoscopic systems with esophageal histopathology findings in pediatric patients.
Main Methods:
- A cohort of 113 children (ages 5-17) undergoing esophagogastroduodenoscopy were retrospectively analyzed.
- Endoscopic reports and images were re-evaluated by a single gastroenterologist using Savary-Miller, Hetzel-Dent, and Los Angeles criteria.
- Esophageal biopsies were re-examined by a pathologist to determine histopathological esophagitis.
Main Results:
- The Hetzel-Dent system identified esophagitis in 64.6% of patients, while Savary-Miller and Los Angeles systems identified it in only 17.7%.
- Excellent consistency was observed between Savary-Miller and Los Angeles classifications (κ=0.92).
- Poor agreement was found between Hetzel-Dent and the other two systems. Histopathological esophagitis was present in 72.6% of patients, with weak consistency across all endoscopic systems.
Conclusions:
- Current adult-developed endoscopic scoring systems appear inadequate for diagnosing pediatric esophagitis due to milder presentations.
- The study suggests a need for revised or novel endoscopic classification systems incorporating sensitive detection of minimal changes.
- Implementing advanced endoscopic techniques could improve diagnostic sensitivity for esophagitis in children.
Background/Aims:
The aim of this study was to evaluate the consistency of the Savary-Miller, the Hetzel-Dent and the Los Angeles endoscopic classification systems and to compare them with the esophageal histopathology in children.
Material And Methods:
Children between the ages of 5-17 years who underwent esophagogastroduodenoscopy were included in the study. The endoscopic reports and the still images of the esophagus were reclassified by the same gastroenterologist according to the Savary-Miller, Hetzel- Dent and Los Angeles scoring systems. The esophageal biopsies were also reevaluated by the same pathologist and the consistency between endoscopic and histopathologic esophagitis was evaluated.
Results:
A total of 113 out of 192 pediatric patients were included in the study. Seventy-three patients (64.6%) had esophagitis according to the Hetzel-Dent classification, whereas only 20 (17.7%) patients were defined as having esophagitis according to the other two classification systems. The consistency between the Savary-Miller and Los Angeles classifications was excellent (κ: 0.92) but the agreement between the Hetzel-Dent and Savary-Miller and between the Hetzel-Dent and Los Angeles classifications were poor. A total of 82 patients (72.6%) had histopathological esophagitis, and there was a weak consistency between all 3 endoscopic scoring systems and the histopathology.
Conclusions:
Since pediatric patients have milder esophagitis than in adults, the use of endoscopic scoring systems developed for adults seems to be inapplicable for children. The inclusion of minimal endoscopic changes in endoscopic scoring systems by using more sensitive and novel endoscopic techniques would increase the sensitivity of these scoring systems in children.
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