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The Yield of Upper Gastrointestinal Endoscopy at a Pediatric Tertiary Care Center
Tal David Berger1,2, Shelly Soffer2, Tal Vurzel-Harel2
1Institute of Gastroenterology, Nutrition, and Liver Disease, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.
Insights
Esophagogastroduodenoscopy (EGD) in children shows a high diagnostic yield when specific conditions are suspected. However, EGD may be less beneficial for diagnosing non-specific abdominal pain in pediatric patients.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Procedures
- Endoscopy
Background:
- Investigative esophagogastroduodenoscopies (EGD) in children have increased, but their diagnostic value is often unclear.
- This trend necessitates an evaluation of the procedure's utility in pediatric care.
Purpose of the Study:
- To assess the indications for pediatric EGD.
- To determine the diagnostic yields of EGD.
- To analyze the impact of EGD on pediatric patient management.
Main Methods:
- A retrospective chart review was conducted.
- The study included pediatric patients aged 0-18 years who underwent EGD between January and August 2014.
Main Results:
- 547 EGDs were performed on 478 children.
- Common indications included suspected celiac disease, chronic abdominal pain, Helicobacter pylori infection, and GI hemorrhage.
- The overall diagnostic yield was 59.2%, with celiac disease (28%) and H. pylori gastritis (16.5%) being frequent diagnoses.
- EGD for unexplained abdominal pain had a lower yield (26.2%) and less symptom improvement (39.3%).
Conclusions:
- EGD demonstrates a high diagnostic yield in pediatric patients when specific conditions are suspected.
- The procedure's role in managing non-specific gastrointestinal complaints is limited, suggesting it may be unnecessary for some cases.
- Optimizing EGD use in children is crucial for effective diagnosis and management.
Background:
The number of investigative esophagogastroduodenoscopies (EGD) in children has increased over several decades, despite their unclear diagnostic yields.
Objectives:
To evaluate the indications for performing EGD, their diagnostic yields, and consequences on pediatric patient management.
Methods:
A retrospective chart review was performed of consecutive pediatric patients aged 0-18 years, who underwent EGD between January and August 2014.
Results:
During the study period, 547 EGD were performed on 478 children. The most frequent indications were suspected celiac disease, chronic non-specific abdominal pain, persistent Helicobacter pylori infection, and gastrointestinal hemorrhage. The yield of the diagnostic EGD was 59.2%, and the most common new diagnoses were celiac disease (28%), Helicobacter pylori-positive gastritis (16.5%), and Crohn's disease (5.4%). Of the patients with documented follow-up, 74.1% reported improved symptoms. Procedures performed for chronic unexplained abdominal pain had significantly lower yields (26.2%) and only 39.3% improved at follow-up.
Conclusions:
Our findings suggest a general high diagnostic yield for EGD in pediatric patients, stemming mainly from patients in whom a specific condition was suspected a priori. However, the role of the procedure in the diagnosis and management of non-specific gastrointestinal complaints was minor suggesting that EGD may be superfluous for some of these patients.
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