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Diagnostic Yield of Upper and Lower Gastrointestinal Endoscopies in Children in a Tertiary Centre
1Department of Paediatric Gastroenterology, Sheffield Children's Hospital, Sheffield S10 2TH, United Kingdom.
Insights
Pediatric endoscopy, including ileocolonoscopy, offers a high diagnostic yield and significantly impacts patient management. A 98% terminal ileum intubation rate demonstrates the effectiveness of these procedures in children.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Endoscopy
- Clinical Outcomes
Background:
- Endoscopic procedures are crucial for diagnosing and managing pediatric gastrointestinal conditions.
- There's a growing global trend in pediatric endoscopy, prompting evaluation of its appropriateness and cost-effectiveness.
Purpose of the Study:
- To assess the diagnostic yield of endoscopy in children at a tertiary referral center.
- To determine the terminal ileum intubation (TII) rate for pediatric ileocolonoscopy (IC) in a training setting and compare it with historical data.
Main Methods:
- Retrospective analysis of 30-month electronic database records (April 2012-October 2014).
- Data collected included presenting symptoms, age, indications, endoscopic and histopathological findings, and changes in management.
- Diagnostic yield and TII rates were calculated; management impact was evaluated.
Main Results:
- The positive diagnostic yield was 18.9% for upper endoscopy alone, 32.6% for IC alone, and 39.2% when both were performed.
- Management was actively changed in 45% of cases based on findings, with significant contribution to management in all patients.
- A high TII rate of 98% was achieved, exceeding the previous rate of 89%.
Conclusions:
- Pediatric ileocolonoscopy has a diagnostic yield of 32.6%, increasing to 39.2% with concurrent upper endoscopy.
- A 98% terminal ileum intubation rate is achievable in pediatric ileocolonoscopy.
- Endoscopic findings significantly alter management in 45% of cases, highlighting the value of these procedures even when negative.
Introduction:
Endoscopy is integral to the diagnosis and management of many gastrointestinal problems in children. Recently the number of endoscopic procedures performed has increased considerably worldwide raising questions about their appropriateness and cost-efficacy.
Objectives:
The aim of the study was to determine the diagnostic yield (the likelihood that a procedure or test will provide information required to establish a diagnosis) of endoscopy in a paediatric population in a large tertiary referral centre and to determine the terminal ileum intubation (TII) rate of paediatric ileocolonosocopy (IC) in an active training environment and compare with previously calculated rates.
Methods:
Random selection of cases from a theatre electronic database from a 30-month period covering April 2012 to October 2014. The data were collected for initial presenting symptoms; age at diagnosis; indications for endoscopy; endoscopic findings; histopathological findings; and any change in management postendoscopic procedure. The diagnostic yield of the endoscopies and the TII rate of IC were calculated. Change in and contribution to management was assessed.
Results:
Median age 9.58 (0.5-16.5) years and M:F ratio 1:1.42. The positive diagnostic yield was 18.9% for oesophago-gastro-duodenoscopy alone, 32.6% for IC alone, and 39.2% when both occurred. In 45% management was actively changed due to endoscopy/histopathology findings and a significant management contribution occurred in all patients. TII was achieved in 98% of cases, which compares favourably to a TII rate of 89% at the same centre during the period 2009 to 2011.
Conclusions:
Diagnostic yield was 32.6% for IC and 39.2% when oesophago-gastro-duodenoscopy also occurred. A TII rate of 98% should be achievable in children. A change in management occurred in 45% and as a significant negative finding may be as important as a positive diagnosis for exclusion of suspected disorders, with consequent reassurance and change in management. Contribution to management was therefore identified in all cases.
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