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Endoscopy in Infants With Gastrointestinal Bleeding Has Limited Diagnostic or Therapeutic Benefit
Paroma Bose1, Annalise S Jacobs2, Jorge Gonzales Cordova2
1From the Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Indiana University School of Medicine/Riley Hospital for Children, Indianapolis, IN.
Insights
Endoscopy in infants with gastrointestinal bleeding (GIB) has limited diagnostic value and carries risks, including perforation. These findings suggest caution when considering endoscopic procedures for GIB in this young population.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Endoscopy
- Infant Health
Background:
- Pediatric gastroenterologists frequently perform diagnostic and therapeutic endoscopy for infant gastrointestinal bleeding (GIB).
- The diagnostic yield and complication risks of endoscopy in infants with GIB are not well-established.
- This study evaluates the utility and safety of endoscopy in this specific patient group.
Purpose of the Study:
- To describe the findings and outcomes of endoscopic procedures performed in infants presenting with GIB.
- To assess the diagnostic value and complication rates associated with endoscopy in infants under 12 months old.
- To inform clinical decision-making regarding the use of endoscopy for GIB in infants.
Main Methods:
- Retrospective, single-center cohort study.
- Inclusion of hospitalized infants (≤12 months) who underwent esophagogastroduodenoscopy or colonoscopy for GIB.
- Data sourced from procedural codes, ICD codes, and quality control logs.
Main Results:
- Seven endoscopies identified bleeding sources including ulcers and varices; three infants received therapeutic interventions.
- Six infants required surgery post-endoscopy, with diagnoses including perforation and necrotizing enterocolitis.
- Factors like respiratory failure and need for vasopressors correlated with increased likelihood of surgery.
Conclusions:
- Endoscopy demonstrated limited utility for diagnosing GIB in infants ≤12 months old.
- Endoscopic procedures in these infants carry significant risks, including a notable rate of post-procedural gastrointestinal perforation.
- The findings underscore the need for careful consideration of risks versus benefits when deciding on endoscopy for infant GIB.
Objectives:
Pediatric gastroenterologists are often consulted to perform diagnostic and therapeutic endoscopy in infants with gastrointestinal bleeding (GIB). The value of endoscopy and risk of complications in this population are not well characterized. We aimed to describe findings and outcomes of infants with GIB who undergo endoscopy.
Methods:
Retrospective, single-center, cohort study of hospitalized infants ≤12 months who underwent esophagogastroduodenoscopy (EGD) and/or colonoscopy/flexible sigmoidoscopy (COL) for GIB. Current procedural technology codes, international classification of diseases codes, and quality control logs identified infants.
Results:
Fifty-six infants were identified from 2008 to 2019 (51.8% female; mean age 161.6 days). Seven endoscopies identified sources of GIB: gastric ulcers, a duodenal ulcer, gastric angiodysplasia, esophageal varices, and an anastomotic ulcer. Three infants underwent therapeutic interventions of banding/sclerotherapy of esophageal varices and triamcinolone injection of an anastomotic ulcer. Six infants underwent abdominal surgery for GIB or suspected intestinal perforation after endoscopy, where a gastric perforation, jejunal perforation at an anastomotic stricture, necrotizing enterocolitis totalis with perforation, Meckel's diverticulum, and a duodenal ulcer were identified. No source of bleeding was identified surgically in 1 infant with GIB. Respiratory failure, use of vasopressors or octreotide, administration of blood products, and high blood urea nitrogen were associated with increased likelihood of requiring surgery ( P < 0.05 for all).
Conclusions:
There was limited utility to performing endoscopy in infants ≤12 months old with clinical GIB. Endoscopy in these sick infants carries risk, and 3 infants in this series presented with a gastrointestinal (GI) perforation shortly after the procedure. These limitations and risks should influence clinical decision-making regarding endoscopy in infants with GIB.
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