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Pediatric esophagogastroduodenoscopy in china: indications, diagnostic yield, and factors associated with findings
Shengnan Wang1, Xiaoxia Qiu1, Jingfang Chen2
1Department of Gastroenterology, Children's Hospital of Fudan University, Shanghai, China.
Insights
Pediatric esophagogastroduodenoscopy (EGD) is most commonly indicated for abdominal pain. Diagnostic yield varies with symptoms like dysphagia, and histologic yield is linked to age, highlighting the importance of alarming features in pediatric endoscopy.
Area of Science:
- Pediatric Gastroenterology
- Endoscopic Diagnostics
Background:
- Large-scale data on pediatric esophagogastroduodenoscopy (EGD) in China is limited.
- Understanding indications and diagnostic yield is crucial for effective pediatric care.
Purpose of the Study:
- To assess the indications and diagnostic yield of EGD in children under 18.
- To investigate the relationship between patient factors (age, sex, indications) and EGD diagnostic yield.
Main Methods:
- A prospective, cross-sectional observational study was conducted across five children's hospitals.
- Data on demographics, EGD indications, and findings were collected from 2268 pediatric patients.
- Univariable and multivariable logistic regression analyses were used to determine associations with diagnostic yield.
Main Results:
- Abdominal pain was the most frequent indication (86.2%) in 2268 children (median age 8.68 years).
- Overall endoscopic yield was 62.5%, highest with dysphagia (90.9%). Histologic yield was 30.4%, highest with unexplained anemia (45.5%).
- Endoscopic yield correlated with dysphagia, GI bleeding, and vomiting; histologic yield correlated with age.
Conclusions:
- Abdominal pain is the primary indication for pediatric EGD, with varied findings.
- Endoscopic and histologic yields are associated with specific alarming symptoms, guiding diagnostic approaches.
Background:
Large-scale data on esophagogastroduodenoscopy (EGD) in China are scarce. This study aimed to assess the indications and diagnostic yield of EGD in children and the relationship between factors (such as age, sex, and indications) and diagnostic yield.
Methods:
We performed a prospective cross-sectional observational study involving patients aged < 18 years who underwent diagnostic EGD. The study was conducted in five children's hospitals, each in a different city. Demographic features, indications for endoscopy, and endoscopic and histopathological findings were collected. Univariable and multivariable ordinal logistic regression analyses of the relationship between the factors and diagnostic yield were performed.
Results:
The study included 2268 patients (male/female ratio, 1.3:1) with a median age of 8.68 years. Among the 2268 children, the most frequent indications were abdominal pain in 1954 (86.2%), recurrent vomiting in 706 (31.1%), weight loss in 343 (15.1%), and others. The endoscopic yield was 62.5% and was the highest in patients with dysphagia (90.9%). The histologic yield was 30.4% and was the highest in patients with unexplained anemia (45.5%). On multivariable regression analysis, the endoscopic yield was associated with dysphagia, gastrointestinal (GI) bleeding, and recurrent vomiting, and the histologic yield was associated with age. Different groups of patients with abdominal pain had variable probabilities of abnormal endoscopic findings.
Conclusions:
The most frequent indication of pediatric EGD is abdominal pain, with variable probabilities of abnormal endoscopic findings in different groups. Endoscopic yield and histologic yield are associated with certain alarming features.
Trial Registration:
The trial registration number (ClinicalTrials. gov): NCT03603093 (The study was registered on 27/07/2018).
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