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Results of esophageal biopsies performed during triple endoscopy in the pediatric patient
B C Stroh1, R A Faust, F L Rimell
1Department of Otolaryngology, University of Minnesota, Minneapolis 55455, USA.
Insights
Adding esophageal biopsies during triple endoscopy in children with respiratory symptoms is safe and effective. This procedure helps diagnose gastroesophageal reflux, a common but often overlooked cause of pediatric airway issues.
Area of Science:
- Pediatric Gastroenterology
- Pediatric Pulmonology
- Diagnostic Endoscopy
Background:
- Direct laryngoscopy and bronchoscopy are standard for pediatric respiratory symptoms of unknown origin.
- Gastroesophageal reflux (GER) is an increasingly recognized cause of pediatric respiratory symptoms.
- Diagnosing GER solely via direct laryngoscopy and bronchoscopy can be challenging.
Purpose of the Study:
- To assess the feasibility, safety, and efficacy of routine esophageal biopsies during triple endoscopy in children.
- To improve the diagnosis of gastroesophageal reflux in pediatric patients with respiratory symptoms.
Main Methods:
- Twenty-four children (2 weeks to 10 years) underwent direct laryngoscopy, bronchoscopy, and esophagoscopy with mucosal biopsies under general anesthesia.
- Esophageal mucosal biopsies were obtained during the endoscopic evaluation.
Main Results:
- Esophageal biopsies were acquired quickly and safely without complications.
- Reflux esophagitis was identified in 54% of biopsy specimens.
- Histological findings indicative of reflux esophagitis included basal cell hyperplasia, papillary elongation, and inflammatory cell infiltrates.
Conclusions:
- Gastroesophageal reflux is frequently difficult to diagnose in children.
- Incorporating esophagoscopy with mucosal biopsies into airway evaluations safely and efficiently provides crucial data on GER's contribution to pediatric respiratory symptoms.
Background:
Endoscopic examination (direct laryngoscopy and bronchoscopy) is the method of choice for diagnosis of respiratory symptoms of unknown cause in children. However, gastroesophageal reflux is being recognized increasingly often as a cause of pediatric respiratory symptoms and is difficult to diagnose on the basis of findings from direct laryngoscopy and bronchoscopy. In cases in which gastroesophageal reflux was included in the differential diagnosis, we additionally performed esophagoscopy with esophageal mucosal biopsies.
Objectives:
To determine the feasibility, safety, and efficacy of routinely performing esophageal biopsies during triple endoscopy in children.
Methods:
Twenty-four children ranging in age from 2 weeks to 10 years were referred for airway evaluation. Under general anesthesia, children underwent direct laryngoscopy and bronchoscopy and esophagoscopy with mucosal biopsy.
Results:
Esophageal mucosa biopsy specimens were quickly and safely obtained during endoscopic evaluation. There were no complications. Reflux esophagitis was present in 54% of biopsy specimens, as suggested by basal cell hyperplasia, papillary elongation, and/or inflammatory cell infiltrates.
Conclusion:
Gastroesophageal reflux is often difficult to diagnose in the pediatric population. When direct laryngoscopy and bronchoscopy is performed during examination of the child with airway symptoms, the addition of esophagoscopy with mucosal biopsies will safely and quickly provide data regarding the potential contribution of gastroesophageal reflux.