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Clinical Presentation and Outcomes of Diagnostic Endoscopy in Newly Presenting Children With Gastrointestinal
Shuang Wang1, Osman Younus1, David Rawat1
1Department of Paediatric Gastroenterology, Royal London Hospital, Barts Health NHS Trust.
Insights
Many pediatric endoscopies yield normal results, indicating a need for better patient selection guidelines. This study analyzed symptoms, investigations, and diagnostic yield in children undergoing endoscopy.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Endoscopy
- Clinical Outcomes
Background:
- Paediatric endoscopy is a crucial diagnostic tool for children.
- Limited data exists to guide the selection of pediatric patients for endoscopic procedures.
- Evaluating the diagnostic yield of endoscopy in children is essential for optimizing its use.
Purpose of the Study:
- To assess the experience of a single center in performing diagnostic endoscopies in newly presenting children.
- To analyze presenting symptoms, investigations performed, and the overall diagnostic yield.
- To identify factors influencing the detection of abnormalities during paediatric endoscopy.
Main Methods:
- A retrospective review of clinical factors and endoscopic/histological findings from first diagnostic endoscopies over a 6-month period.
- Inclusion of 164 children undergoing 218 endoscopies (oesophagogastroduodenoscopy and/or colonoscopy).
- Histopathology results were reviewed in a multidisciplinary team meeting, with abnormal histology defining the criterion standard.
Main Results:
- Approximately 65% of paediatric endoscopies reviewed were histologically normal.
- Macroscopic and histological abnormalities varied by procedure: OGD (44%/28%), colonoscopy (25%/25%), and OGD&Col (53%/53%).
- Vomiting was the most common symptom associated with abnormal histology in OGD-only patients (22%), while rectal bleeding predominated in colonoscopy-only (14%) and OGD&Col (29%) patients.
Conclusions:
- Half of all first diagnostic endoscopies in the studied pediatric cohort revealed no macroscopic or histological abnormalities.
- Discrepancies were observed between macroscopic findings and histological results in oesophagogastroduodenoscopy.
- Prospective studies are required to develop evidence-based guidelines for patient selection and improve the predictive accuracy for endoscopic findings in children.
Objectives:
Paediatric endoscopy is an important diagnostic tool; however, there is little published data to guide clinicians in selecting patients for endoscopy. This study aimed to evaluate a single centre's experience of newly presenting children focusing on presenting symptoms, investigations, and diagnostic yield.
Methods:
Clinical factors and endoscopic plus histological findings over a 6-month period were assessed. Only first diagnostic endoscopies were included. All biopsies were reviewed in a weekly histopathology multidisciplinary team meeting with a final agreed outcome. Abnormal histology was used as the criterion standard for reporting abnormality.
Results:
A total of 218 endoscopies were reviewed in 164 children. Approximately 65% were histologically normal (49% of children had macroscopically and histologically normal findings). Macroscopic and histological abnormalities (respectively) were 44% and 28% of oesophagogastroduodenoscopy (OGD) patients, 25% and 25% of colonoscopy alone, and 53% and 53% of those undergoing both OGD and colonoscopy (OGD&Col). For OGD-only patients, excluding those with raised anti-tissue transglutaminase antibodies, vomiting led to the highest rate of abnormal histology (22%). For colonoscopy-only and OGD&Col patients, per rectum bleeding led to the highest rates of abnormal histology (14% and 29%, respectively), after excluding those with laboratory abnormalities (anaemia and raised erythrocyte sedimentation rate) suggestive of inflammatory bowel disease.
Conclusions:
This study showed that half of all first diagnostic endoscopies in our unit had neither macroscopic nor histological abnormalities. There was discrepancy between macroscopic abnormalities and histological findings in OGD. Prospective studies are needed to develop guidelines in appropriately predicting abnormality and selecting patients for endoscopy.
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