Pediatric Gastrointestinal Endoscopy: Diagnostic Yield and Appropriateness of Referral Based on Clinical
Tahel Fachler1,2, Eyal Shteyer1,2, Esther Orlanski Meyer1
1Shaare Zedek Medical Center, Jerusalem, Israel.
Insights
Pediatric gastrointestinal endoscopy (GIE) is safe and effective for diagnosing various symptoms. Diagnostic yield varies by indication, helping guide clinical decisions for children.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Endoscopy
Background:
- Lack of evidence-based consensus on the utility of gastrointestinal endoscopy (GIE) in common pediatric symptoms.
- Need for data to support clinical decision-making in pediatric endoscopy referrals.
Purpose of the Study:
- To assess the diagnostic yield of GIE in children across various indications.
- To provide evidence for optimizing referral practices in pediatric endoscopy.
Main Methods:
- Retrospective analysis of pediatric patients (≤18 years) undergoing GIE.
- Exclusion of patients with predefined indications, follow-up, or therapeutic procedures.
- Recording of referral indications, endoscopic findings, and histologic results.
Main Results:
- 329 pediatric GIEs analyzed; no significant complications reported.
- Diagnostic yield varied by indication: abdominal pain (36%), chronic diarrhea (43%), failure to thrive (42%), short stature (46%), iron deficiency (54%), weight loss (42%).
- Iron deficiency and short stature showed higher diagnostic yields.
Conclusions:
- Pediatric GIE is a safe procedure with diverse indications.
- The diagnostic utility of GIE in children is indication-dependent.
- Findings support the development of judicious referral guidelines for pediatric endoscopy.
Abstract:
Objectives: There is a lack of evidence-based consensus for the utility of gastrointestinal endoscopy (GIE) in an array of frequently occurring symptoms in children. We aimed to assess the diagnostic yield of endoscopy in an effort to aid clinical decision making. Methods: Retrospective analysis included patients ≤18 years who underwent GIE during one calendar year at Shaare Zedek Medical Center. We excluded children referred for predefined obvious indications for GIE, planned follow-up procedures, and therapeutic endoscopy. Clinician-assigned indication for endoscopy as well as endoscopic and histologic findings were recorded. Diagnostic yield of GIE was determined according to referral indication. Results: There were 794 endoscopies performed of which 329 were included in the analysis (mean age 9.3 ± 5.0 years, 51% female). No significant complications of GIE were recorded. Six major referral indications were identified among which abdominal pain was the most frequent 88/329 (26%) of whom 32/88 (36%) had a significant diagnostic finding. Among the other major indications, diagnostic findings were found in 36/85 (43%) children with primary indication of chronic diarrhea, 14/33 (42%) failure to thrive, 15/32 (46%) short stature, 30/56 (54%) iron deficiency, and 20/48 (42%) weight loss. Conclusions: Pediatric GIE is a safe procedure with diverse clinical indications. The diagnostic yield of endoscopy is variable, depending on the referral indication. These data can assist formulating judicious referral practices.
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