Yield of Endoscopy in Pediatric Gastroparesis
Tara A Altepeter1, Stephen Shaffer
1*US Food and Drug Administration, Center for Drug Evaluation and Research, Division of Gastroenterology and Inborn Errors Products, Silver Spring, MD †Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE.
Insights
Upper endoscopy is crucial for diagnosing pediatric gastroparesis, revealing significant findings in both patients and controls. Routine biopsies are recommended due to frequent histologic changes without gross abnormalities.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Yield of Endoscopy
- Gastroparesis Etiology
Background:
- Gastroparesis diagnosis in children often relies on symptom assessment and gastric emptying studies.
- The role and diagnostic yield of upper endoscopy in this population require further clarification.
- Identifying reliable clinical predictors for gastroparesis is essential for timely diagnosis.
Purpose of the Study:
- To quantify the diagnostic yield of upper endoscopy in children suspected of having gastroparesis.
- To develop a clinical model for gastroparesis using common symptoms and screening blood tests.
- To evaluate the correlation between symptoms, laboratory values, and gastroparesis diagnosis.
Main Methods:
- Retrospective chart review of 196 pediatric patients (ages 4-18) evaluated for gastroparesis.
- Analysis of upper endoscopy (gross and histologic) and gastric emptying scan findings.
- Collection of symptom-based data, including dyspeptic and "red-flag" symptoms.
Main Results:
- Clinically significant endoscopic findings were observed in 43% of gastroparetics and 35% of controls (P=0.345).
- Histologic findings (gastritis, esophagitis, duodenitis) were common, but concordance between gross and histologic findings was low (50%).
- No meaningful correlation was found between symptoms/screening labs and gastroparesis diagnosis.
Conclusions:
- Upper endoscopy is an important tool in evaluating pediatric patients with dyspeptic symptoms and suspected gastroparesis.
- Routine biopsies during endoscopy are necessary due to frequent histologic changes not apparent on gross examination.
- A comprehensive evaluation, including endoscopy with biopsy and gastric emptying scan, is required for accurate diagnosis.
Objectives:
The aim of the study was to quantify the diagnostic yield of upper endoscopy in children with gastroparesis and to develop a clinical model for gastroparesis using common symptoms and screening blood tests.
Methods:
We retrospectively reviewed charts of 196 patients of age 4 to 18 years evaluated for gastroparesis between 2009 and 2013. All patients completed a standard solid-phase gastric emptying scan and upper endoscopy within a 12-month period. We analyzed gross and histologic endoscopy findings. Symptom-based data were collected on dyspeptic symptoms and classic "red-flag" symptoms.
Results:
Seventy patients with gastroparesis and 126 controls were included. Clinically significant endoscopic findings were noted in 35% of controls (44/126) and 43% of gastroparetics (30/70), P = 0.345. Concordance between gross and histologic findings was low at 50%. Histologic findings included gastritis 60% (17/28), esophagitis 39% (11/28), and duodenitis 7% (2/28). In univariate and multivariate analyses, there was no meaningful correlation between symptoms and/or screening laboratory values and diagnosis of gastroparesis.
Conclusions:
Clinically significant endoscopy findings were common in both controls and gastroparetics. As more than one-third of patients had findings on endoscopy, we conclude that upper endoscopy remains an important part of the evaluation process of patients with dyspeptic symptoms and suspected gastroparesis. As gross abnormalities were frequently not present with histologic changes, routine biopsy is required. There was no association between studied symptoms and the presence of gastroparesis. A comprehensive evaluation of children with dyspeptic symptoms requires endoscopy with biopsy and solid-phase gastric emptying scan to determine the underlying diagnosis.
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