Diagnostic Yield Variation with Colonoscopy among Pediatric Endoscopists

The primary aim of our study was to determine provider variation in diagnostic yield in a pediatric endoscopy center. Secondary aims were to examine ileal intubation rates as well as procedural complications at the provider level.

A retrospective review of sequential pediatric patients who underwent a colonoscopy, completed by June 2018, determined the rates of endoscopically abnormal (EA) and isolated histologically abnormal (IHA) colonoscopies; the overall diagnostic yield was the combination of EA and IHA.

In total, 374 charts were reviewed. This study found high variability in diagnostic yield among the 16 clinicians ranging from as low as 22% to as high as 86% (p = 0.11) with an overall diagnostic yield of 48% for colonoscopy; excluding follow-up colonoscopies, the diagnostic yield was 42%. Abnormal calprotectin and abnormal blood tests were associated with higher diagnostic yields of 83 and 65%, respectively, compared with symptoms such as abdominal pain, diarrhea, and rectal bleeding which had yields of 39, 43, and 61%. Ileal intubation rates averaged 90% (range -63-100%, p = 0.06). In patients with a normal colon, there were 21 (6%) patients with an EA ileum and an additional 16 (4%) with an IHA ileum. Prep quality was rated excellent, good, or average in 97%. In addition, there was a low rate of serious complications (1 of 374).

This study highlights the individual variability in diagnostic yield and ileal intubation rates in a pediatric gastroenterology practice. Goals for pediatric endoscopy could include ileal intubation rates of >90% and provider diagnostic yields of >40%.