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Flexible Sigmoidoscopy Utility in the Diagnosis of Pediatric Gastrointestinal Disorders
Catalina Jaramillo1, Anna K Ermarth1, John S Collier1
1Pediatric Gastroenterology, University of Utah Health, Salt Lake City, USA.
Insights
Flexible sigmoidoscopy (FS) has a low diagnostic yield in children for gastrointestinal conditions. This pediatric endoscopy rarely changes patient management, suggesting it is not a helpful diagnostic tool.
Area of Science:
- Pediatric Gastroenterology
- Endoscopic Procedures
- Diagnostic Yield Analysis
Background:
- Flexible sigmoidoscopy (FS) is used in pediatric patients for diagnosing gastrointestinal conditions like inflammatory bowel disease.
- The diagnostic utility of FS in the pediatric population remains unclear.
Purpose of the Study:
- To determine the diagnostic yield of flexible sigmoidoscopy in children.
- To evaluate the impact of FS findings on patient management in a pediatric cohort.
Main Methods:
- Retrospective review of 354 pediatric flexible sigmoidoscopy cases over five years.
- Analysis included indications, visual and histologic findings, final diagnoses, and management changes.
Main Results:
- Only 11.3% of cases showed abnormal visual findings and 13.6% abnormal histologic findings.
- Abnormal findings from FS led to a change in management in only 9.6% of cases.
- Functional abdominal pain was the most common diagnosis for non-diagnostic FS, while colitis was common for diagnostic FS.
Conclusions:
- Flexible sigmoidoscopy demonstrates a limited diagnostic yield in pediatric patients.
- FS is not considered a helpful diagnostic intervention, particularly in children with non-concerning clinical presentations.
Aim:
Although flexible sigmoidoscopy (FS) is utilized in children for the diagnosis of pediatric gastrointestinal conditions, such as inflammatory bowel disease and juvenile polyp disorders, the diagnostic yield of FS in pediatric patients is unknown.
Materials And Methods:
We retrospectively reviewed FS cases in children under 18 years of age over a five-year period at our institution. Indications for the procedure, endoscopic visual findings, histologic findings, final diagnosis, and any management changes based on FS findings were included.
Results:
A total of 354 cases were included in the analysis for which 40 cases (11.3%) had abnormal visual findings, 48 cases (13.6%) had abnormal histologic findings, and 13 cases (3.7%) had both abnormal endoscopic visual and histologic findings. Of the 88 cases with abnormal visual and/or histologic abnormalities, only the results of 34 of these FS cases led to a change in management based on endoscopic findings (9.6%). Most patients with a non-diagnostic FS had a final diagnosis of functional abdominal pain; most patients with a diagnostic FS had a final diagnosis of colitis, not otherwise specified.
Conclusion:
Our findings suggest that FS is not a helpful diagnostic endoscopic intervention in pediatric patients, especially in children with reassuring history and physical exam findings.
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