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Wongteerasut A. Which Alarm Symptoms Are Associated With Abnormal Gastrointestinal Endoscopy Among Thai Children? Pediatr Gastroenterol Hepatol Nutr 2024; 27:113-124. [PMID: 38510584 PMCID: PMC10948965 DOI: 10.5223/pghn.2024.27.2.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 09/18/2023] [Accepted: 10/27/2023] [Indexed: 03/22/2024] Open
Abstract
Purpose Alarm symptoms (red flag signs) are crucial indications for management decisions on pediatric gastrointestinal endoscopy. We aimed to identify items in the alarm symptoms and pre-endoscopic investigations that predict abnormal endoscopy results. Methods A retrospective descriptive study was conducted among children aged under 18 years undergoing endoscopy. The patients were classified into normal and abnormal endoscopic groups. The incidence of alarm symptoms and pre-endoscopic investigations were compared between the groups. Univariate and multivariate logistic regression analyses were performed to determine independent risk factors for abnormal endoscopy. Results Of 148 participants, 66 were classified in the abnormal endoscopy group. Compared with the normal group, the abnormal group had a significantly higher prevalence of alarm symptoms. Moreover, hematemesis/hematochezia, anemia, low hemoglobin level, hypoalbuminemia, rising erythrocyte sedimentation rate, increased serum lipase, and blood urea nitrogen/creatinine ratio were significantly higher in the abnormal endoscopy group than in the normal group. Multivariate logistic regression analysis indicated that hematemesis/hematochezia and low hemoglobin level were independent risk factors for abnormal endoscopy. Conclusion The alarm symptoms and pre-endoscopic investigations were evaluated using predictive factors for abnormal pediatric endoscopic findings. According to multivariate logistic regression analysis, hematemesis/hematochezia and low hemoglobin levels were independent risk factors for abnormal endoscopy.
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Affiliation(s)
- Anundorn Wongteerasut
- Department of Pediatrics, Phramongkutklao Hospital and Phramongkutklao College of Medicine, Bangkok, Thailand
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Elhodhod MA, Hamdy AM, Fahmy PO, Awad YM. Diagnostic yield of esophagogastroduodenoscopy in upper gastrointestinal bleeding in pediatrics: a cross-sectional study at a tertiary center. EGYPTIAN PEDIATRIC ASSOCIATION GAZETTE 2023. [DOI: 10.1186/s43054-022-00153-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
Abstract
Background
Esophagogastroduodenoscopy (EGD) is currently considered the first-line diagnostic procedure of choice for upper gastrointestinal bleeding (UGIB); however, the etiology of bleeding remains unknown in a subset of patients. This study aimed to evaluate the diagnostic yield of EGD in UGIB in pediatrics and determine the clinical predictors for positive endoscopic diagnosis.
Methods
A cross-sectional study was conducted at the pediatrics endoscopy unit, Ain Shams University, Cairo, Egypt, where 100 children were included. They were referred for EGD due to overt UGIB in the form of hematemesis and/or melena. Full medical history, thorough physical examination, laboratory investigations, and endoscopic and histopathologic findings were documented.
Results
Forty-seven males and 54 females were included. Their ages ranged from 3 months to 15 years, with a median age of 4 years. Sixty-five percent presented with hematemesis only, 7% presented with melena only, and 28% presented with hematemesis and melena. An endoscopic diagnosis could be reached in 62% of cases, with Helicobacter pylori (H. pylori) gastritis (23%) and reflux esophagitis (11%) as the most common endoscopic diagnoses, with the former being the most common in children above 4 years and the latter for younger ones. Other diagnoses included non-specific gastritis (8%) and esophageal varices (4%). Presentation with melena only was a negative predictor to reach a diagnosis by EGD, while splenomegaly and thrombocytopenia were independent predictors of variceal bleeding.
Conclusion
EGD is the investigation of choice in children suffering from hematemesis especially in older age groups. Clinical and laboratory parameters might help in the prediction of the underlying etiology.
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Saleh NE, Sharaf HM, Elnemr HI, Elzeiny SM, Ali KM, Nabih N. Intestinal Giardiasis in Children Undergoing Upper Endoscopy for Unexplained Gastrointestinal Symptoms: Implication for Diagnosis. Fetal Pediatr Pathol 2023; 42:18-29. [PMID: 35302404 DOI: 10.1080/15513815.2022.2053013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Giardia lamblia is a flagellated protozoan causing diarrheal outbreaks worldwide. Microscopic stool examination is widely used. We conducted this study to explore intestinal giardiasis in children undergoing upper endoscopy for unexplained gastrointestinal symptoms. METHODS The study included 160 children undergoing upper endoscopy for unexplained gastrointestinal symptoms (patients) and 90 children as controls. We collected stool samples for microscopic examination and ELISA coproantigen detection from all participants. We examined duodenal biopsies for patients. RESULTS In patients, stool examination revealed Giardia in 23.8% and coproantigen detection was positive in 37.5%. Endoscopic duodenal biopsies revealed Giardia trophozoites in 5% of patients, in addition to various pathological changes. CONCLUSION Giardiasis was significantly higher (P = 0.001) in children with unexplained gastrointestinal complaints than the controls. Diagnosis by coproantigen detection was superior to microscopic stool examination, with a sensitivity of 90.9%. Duodenal biopsies examination confirmed the infection in fewer cases but added other diagnostic information.
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Affiliation(s)
- Nora E Saleh
- Department of Medical Parasitology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Hend M Sharaf
- Department of Medical Parasitology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Hossam I Elnemr
- Department of Medical Parasitology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Sherine M Elzeiny
- Department of Pediatric Medicine, Children's Hospital, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Khadiga M Ali
- Department of Pathology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Nairmen Nabih
- Department of Medical Parasitology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Wang S, Qiu X, Chen J, Mei H, Yan H, You J, Huang Y. Pediatric esophagogastroduodenoscopy in china: indications, diagnostic yield, and factors associated with findings. BMC Pediatr 2022; 22:522. [PMID: 36056317 PMCID: PMC9438071 DOI: 10.1186/s12887-022-03558-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 08/12/2022] [Indexed: 11/15/2022] Open
Abstract
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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Affiliation(s)
- Shengnan Wang
- Department of Gastroenterology, Children's Hospital of Fudan University, Shanghai, China
| | - Xiaoxia Qiu
- Department of Gastroenterology, Children's Hospital of Fudan University, Shanghai, China
| | - Jingfang Chen
- Department of Gastroenterology, Children's Hospital of Fudan University Xiamen Branch, Xiamen, China
| | - Hong Mei
- Department of Gastroenterology, Wuhan Children's Hospital, Wuhan, China
| | - Haiyan Yan
- Department of Gastroenterology, Henan Children's Hospital (Zhengzhou Children's Hospital), Zhengzhou, China
| | - Jieyu You
- Department of Gastroenterology, Hunan Children's Hospital, Changsha, China
| | - Ying Huang
- Department of Gastroenterology, Children's Hospital of Fudan University, Shanghai, China.
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Paediatric gastrointestinal endoscopy: Experience in Red Cross War Memorial Children’s Hospital, Cape Town, South Africa. SOUTH AFRICAN JOURNAL OF CHILD HEALTH 2022. [DOI: 10.7196/sajch.2022.v16i2.1816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background. Endoscopy is an important diagnostic and therapeutic mode of management in children with gastrointestinal disorders.
Objective. To determine the indications, endoscopic yields and impact of the service on the ongoing health and complications among children who underwent gastrointestinal endoscopy at Red Cross War Memorial Children’s Hospital, Cape Town.
Methods. A 10-year (2007 - 2016) retrospective study of children <18 years old who underwent gastrointestinal endoscopy was undertaken using relevant patients’ variables obtained from their hospital medical records. Data were analysed using Stata 13.1 (p<0.05).
Results. A total of 402 children underwent a total of 695 gastrointestinal endoscopic procedures: 592 (85.2%) were gastroscopies, 78 (11.2%) combined gastroscopies with colonoscopies and 25 (3.6%) colonoscopy-only procedures, respectively. The main diagnostic indications for gastroscopy, gastroscopy combined with colonoscopy and colonoscopy-only were chronic abdominal pain (n=49; 12.2%), suspected inflammatory bowel disease (n=30; 7.5%) and rectal bleeding (n=13; 52.0%) respectively. The most common therapeutic indication for gastroscopy was change of a percutaneous endoscopic gastrostomy (n=143; 35.6%) while for colonoscopy 6 (5.8%) had polypectomy. Abnormal histopathological results were made from both macroscopically normal- and abnormal-looking tissues, though with no statistically significant relationship.
Conclusion. Endoscopy offers diagnostic and therapeutic options in children. Positive histological findings were obtained in some cases where gastrointestinal mucosae appeared normal. There is need to obtain biopsies from both macroscopically normal- and abnormallooking gastrointestinal mucosae as positive histological findings could be made from them and hence improve diagnostic yield.
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Virkkula A, Kivela L, Hiltunen P, Sotka A, Huhtala H, Kurppa K, Repo M. Prevalence and Clinical Significance of Helicobacter Pylori-negative Chronic Gastritis in Children. J Pediatr Gastroenterol Nutr 2022; 74:949-955. [PMID: 35258500 DOI: 10.1097/mpg.0000000000003440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES The clinical significance of Helicobacter pylori-negative chronic gastritis (HPNCG) in children is unclear. We examined this issue in patients who had undergone esophagogastroduodenoscopy with systematic gastric sampling. METHODS Data of 1178 consecutive children who underwent diagnostic esophagogastroduodenoscopy were collected. Baseline characteristics and long-term outcomes were compared between children with active and inactive HPNCG and those with normal gastric histology. Follow-up data were available for up to 13 years. RESULTS Altogether 24 (2.0%) children had active and 235 (19.9%) inactive HPNCG, 27 (2.3%) were Hpylori-positive, 46 (3.9%) had other gastric pathology, and 846 (71.8%) normal histology. Diarrhea (31.3% vs 25.1%, P = 0.033), poor growth (23.6% vs 14.7%, P < 0.001), bloody stools (13.9% vs 7.2%, P < 0.001), anemia (46.5% vs 23.4%, P < 0.001), hypersedimentation (39.7% vs 21.4%, P < 0.001), hypoalbuminemia (40.4% vs 16.2%, P < 0.001), and elevated fecal calprotectin (62.4% vs 31.5%, P < 0.001) were more common and heartburn (13.9% vs 22.9%, P = 0.002) less common in the HPNCG group than in the controls. Both active (OR 3.64,95% CI 1.35-9.82) andinactive (2.98, 2.18-4.08) HPNCG predicted a diagnosis in the initial investigations. Crohn disease (41.7%) was the most common diagnosis in active HPNCG and celiac disease (37.4%) in inactive HPNCG. During follow-up, 7 (9.9%) of the 71 initially nondiagnosed HPNCG children received a diagnosis. CONCLUSIONS HPNCG is a frequent finding in children undergoing EGD, the active form being associated especially with Crohn disease and the inactive with celiac disease. The long-term prognosis of patients with HPNCG who do not receive an initial diagnosis is good.
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Affiliation(s)
- Anni Virkkula
- Tampere Centre for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Laura Kivela
- Tampere Centre for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Celiac Disease Research Centre, Faculty of Medicine and Health Technology, Tampere university, Tampere
- University of Helsinki and Helsinki University Hospital, Children's Hospital, and Paediatric Research Center, Helsinki
| | - Pauliina Hiltunen
- Tampere Centre for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Pediatrics, Tampere University Hospital, Tampere
| | - Antti Sotka
- Department of Pediatrics, South Karelia Central Hospital, Lappeen-ranta
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Tampere
| | - Kalle Kurppa
- Tampere Centre for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Celiac Disease Research Centre, Faculty of Medicine and Health Technology, Tampere university, Tampere
- University Consortium of Seinajoki and Seinajoki Central Hospital, Seinajoki, Finland
| | - Marleena Repo
- Tampere Centre for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Celiac Disease Research Centre, Faculty of Medicine and Health Technology, Tampere university, Tampere
- Department of Pediatrics, Central Finland Central Hospital, Jyvaskyla, Finland
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7
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Lightdale JR, Walsh CM, Oliva S, Jacobson K, Huynh HQ, Homan M, Hojsak I, Gillett PM, Furlano RI, Fishman DS, Croft NM, Brill H, Bontems P, Amil-Dias J, Utterson EC, Tavares M, Rosh JR, Riley MR, Narula P, Mamula P, Mack DR, Liu QY, Lerner DG, Leibowitz IH, Otley AR, Kramer RE, Ambartsumyan L, Connan V, McCreath GA, Thomson MA. Pediatric Endoscopy Quality Improvement Network Quality Standards and Indicators for Pediatric Endoscopic Procedures: A Joint NASPGHAN/ESPGHAN Guideline. J Pediatr Gastroenterol Nutr 2022; 74:S30-S43. [PMID: 34402486 DOI: 10.1097/mpg.0000000000003264] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION High-quality pediatric gastrointestinal procedures are performed when clinically indicated and defined by their successful performance by skilled providers in a safe, comfortable, child-oriented, and expeditious manner. The process of pediatric endoscopy begins when a plan to perform the procedure is first made and ends when all appropriate patient follow-up has occurred. Procedure-related standards and indicators developed to date for endoscopy in adults emphasize cancer screening and are thus unsuitable for pediatric medicine. METHODS With support from the North American and European Societies of Pediatric Gastroenterology Hepatology and Nutrition (NASPGHAN and ESPGHAN), an international working group of the Pediatric Endoscopy Quality Improvement Network (PEnQuIN) used the methodological strategy of the Appraisal of Guidelines for REsearch and Evaluation (AGREE) II instrument to develop standards and indicators relevant for assessing the quality of endoscopic procedures. Consensus was sought via an iterative online Delphi process and finalized at an in-person conference. The quality of evidence and strength of recommendations were rated according to the GRADE (Grading of Recommendation Assessment, Development, and Evaluation) approach. RESULTS The PEnQuIN working group achieved consensus on 14 standards for pediatric endoscopic procedures, as well as 30 indicators that can be used to identify high-quality procedures. These were subcategorized into three subdomains: Preprocedural (3 standards, 7 indicators), Intraprocedural (8 standards, 18 indicators), and Postprocedural (3 standards, 5 indicators). A minimum target for the key indicator, "rate of adequate bowel preparation," was set at ≥80%. DISCUSSION It is recommended that all facilities and individual providers performing pediatric endoscopy worldwide initiate and engage with the procedure-related standards and indicators developed by PEnQuIN to identify gaps in quality and drive improvement.
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Affiliation(s)
- Jenifer R Lightdale
- Department of Pediatrics, Division of Gastroenterology and Nutrition, UMass Memorial Children's Medical Center, University of Massachusetts Medical School, Worcester, MA, United States
| | - Catharine M Walsh
- Department of Paediatrics and the Wilson Centre, Division of Gastroenterology, Hepatology and Nutrition and the Research and Learning Institutes, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Salvatore Oliva
- Pediatric Gastroenterology and Liver Unit, Maternal and Child Health Department, Umberto I - University Hospital, Sapienza - University of Rome, Rome, Italy
| | - Kevan Jacobson
- Division of Gastroenterology, Hepatology and Nutrition, British Columbia's Children's Hospital and British Columbia Children's Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hien Q Huynh
- Pediatric Gastroenterology and Nutrition, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Matjaž Homan
- Department of Gastroenterology, Faculty of Medicine, Hepatology and Nutrition, University Children's Hospital, University of Ljubljana, Ljubljana, Slovenia
| | - Iva Hojsak
- Referral Center for Pediatric Gastroenterology and Nutrition, Children's Hospital Zagreb, University of Zagreb Medical School, Zagreb, University J.J. Strossmayer Medical School, Osijek, Croatia
| | - Peter M Gillett
- Paediatric Gastroenterology, Hepatology and Nutrition Department, Royal Hospital for Sick Children, Edinburgh, Scotland, United Kingdom
| | - Raoul I Furlano
- Pediatric Gastroenterology & Nutrition, Department of Pediatrics, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Douglas S Fishman
- Section of Pediatric Gastroenterology, Hepatology and Nutrition, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States
| | - Nicholas M Croft
- Blizard Institute, Barts and the London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - Herbert Brill
- Department of Pediatrics, Division of Gastroenterology & Nutrition, McMaster Children's Hospital, McMaster University, William Osler Health System, University of Toronto, Toronto, Ontario, Canada
| | - Patrick Bontems
- Division of Pediatrics, Department of Pediatric Gastroenterology, Queen Fabiola Children's University Hospital, ICBAS - Université Libre de Bruxelles, Brussels, Belgium
| | - Jorge Amil-Dias
- Pediatric Gastroenterology, Department of Pediatrics, Centro Hospitalar Universitário S. João, Porto, Portugal
| | - Elizabeth C Utterson
- Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Washington University School of Medicine/St. Louis Children's Hospital, St. Louis, MO, United States
| | - Marta Tavares
- Division of Pediatrics, Pediatric Gastroenterology Department, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, ICBAS - Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
| | - Joel R Rosh
- Division of Pediatric Gastroenterology, Department of Pediatrics, Goryeb Children's Hospital, Icahn School of Medicine at Mount Sinai, Morristown, NJ, United States
| | - Matthew R Riley
- Department of Pediatric Gastroenterology, Providence St. Vincent's Medical Center, Portland, OR, United States
| | - Priya Narula
- Department of Paediatric Gastroenterology, Sheffield Children's NHS Foundation Trust, Sheffield, South Yorkshire, United Kingdom
| | - Petar Mamula
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - David R Mack
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Quin Y Liu
- Division of Gastroenterology and Hepatology, Medicine and Pediatrics, Cedars-Sinai Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Diana G Lerner
- Division of Pediatrics, Pediatric Gastroenterology, Hepatology and Nutrition, Children's of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Ian H Leibowitz
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Children's National Medical Center, George Washington University, Washington, DC, United States
| | - Anthony R Otley
- Gastroenterology & Nutrition, Department of Pediatrics, IWK Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Robert E Kramer
- Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Children's Hospital of Colorado, University of Colorado, Aurora, CO, United States
| | - Lusine Ambartsumyan
- Department of Pediatrics, Division of Gastroenterology and Hepatology, Seattle Children's Hospital, University of Washington, Seattle, WA, United States
| | - Veronik Connan
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Graham A McCreath
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mike A Thomson
- Department of Paediatric Gastroenterology, Sheffield Children's NHS Foundation Trust, Sheffield, South Yorkshire, United Kingdom
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Walsh CM, Lightdale JR, Fishman DS, Furlano RI, Mamula P, Gillett PM, Narula P, Hojsak I, Oliva S, Homan M, Riley MR, Huynh HQ, Rosh JR, Jacobson K, Tavares M, Leibowitz IH, Utterson EC, Croft NM, Mack DR, Brill H, Liu QY, Bontems P, Lerner DG, Amil-Dias J, Kramer RE, Otley AR, Ambartsumyan L, Connan V, McCreath GA, Thomson MA. Pediatric Endoscopy Quality Improvement Network Pediatric Endoscopy Reporting Elements: A Joint NASPGHAN/ESPGHAN Guideline. J Pediatr Gastroenterol Nutr 2022; 74:S53-S62. [PMID: 34402488 DOI: 10.1097/mpg.0000000000003266] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION High-quality procedure reports are a cornerstone of high-quality pediatric endoscopy as they ensure the clear communication of procedural events and outcomes, guide patient care and facilitate continuous quality improvement. The aim of this document is to outline standardized reporting elements that achieved international consensus as requirements for high-quality pediatric endoscopy procedure reports. METHODS With support from the North American and European Societies of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN and ESPGHAN), an international working group of the Pediatric Endoscopy Quality Improvement Network (PEnQuIN) used Delphi methodology to identify key elements that should be found in all pediatric endoscopy reports. Item reduction was attained through iterative rounds of anonymized online voting using a 6-point scale. Responses were analyzed after each round and items were excluded from subsequent rounds if ≤50% of panelists rated them as 5 ("agree moderately") or 6 ("agree strongly"). Reporting elements that ≥70% of panelists rated as "agree moderately" or "agree strongly" were considered to have achieved consensus. RESULTS Twenty-six PEnQuIN group members from 25 centers internationally rated 63 potential reporting elements that were generated from a systematic literature review and the Delphi panelists. The response rates were 100% for all three survey rounds. Thirty reporting elements reached consensus as essential for inclusion within a pediatric endoscopy report. DISCUSSION It is recommended that the PEnQuIN Reporting Elements for pediatric endoscopy be universally employed across all endoscopists, procedures and facilities as a foundational means of ensuring high-quality endoscopy services, while facilitating quality improvement activities in pediatric endoscopy.
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Affiliation(s)
- Catharine M Walsh
- Division of Gastroenterology, Hepatology and Nutrition and the Research and Learning Institutes, The Hospital for Sick Children, Department of Paediatrics and the Wilson Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jenifer R Lightdale
- Division of Gastroenterology and Nutrition, UMass Memorial Children's Medical Center, Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, United States
| | - Douglas S Fishman
- Section of Pediatric Gastroenterology, Hepatology and Nutrition, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States
| | - Raoul I Furlano
- Pediatric Gastroenterology & Nutrition, Department of Pediatrics, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Petar Mamula
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Peter M Gillett
- Paediatric Gastroenterology, Hepatology and Nutrition Department, Royal Hospital for Sick Children, Edinburgh, Scotland, United Kingdom
| | - Priya Narula
- Department of Paediatric Gastroenterology, Sheffield Children's NHS Foundation Trust, Sheffield, South Yorkshire, United Kingdom
| | - Iva Hojsak
- Referral Center for Pediatric Gastroenterology and Nutrition, Children's Hospital Zagreb, University of Zagreb Medical School, Zagreb, University J.J. Strossmayer Medical School, Osijek, Croatia
| | - Salvatore Oliva
- Pediatric Gastroenterology and Liver Unit, Maternal and Child Health Department, Umberto I - University Hospital, Sapienza - University of Rome, Rome, Italy
| | - Matjaž Homan
- Department of Gastroenterology, Hepatology and Nutrition, University Children's Hospital, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Matthew R Riley
- Department of Pediatric Gastroenterology, Providence St. Vincent's Medical Center, Portland, OR, United States
| | - Hien Q Huynh
- Pediatric Gastroenterology and Nutrition, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Joel R Rosh
- Division of Pediatric Gastroenterology, Department of Pediatrics, Goryeb Children's Hospital, Icahn School of Medicine at Mount Sinai, Morristown, NJ, United States
| | - Kevan Jacobson
- Division of Gastroenterology, Hepatology and Nutrition, British Columbia's Children's Hospital and British Columbia Children's Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marta Tavares
- Division of Pediatrics, Pediatric Gastroenterology Department, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, ICBAS - Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
| | - Ian H Leibowitz
- Division of Gastroenterology, Hepatology and Nutrition, Children's National Medical Center, Department of Pediatrics, George Washington University, Washington, DC, United States
| | - Elizabeth C Utterson
- Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Washington University School of Medicine/St. Louis Children's Hospital, St. Louis, MO, United States
| | - Nicholas M Croft
- Blizard Institute, Barts and the London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - David R Mack
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Herbert Brill
- Division of Gastroenterology & Nutrition, Department of Pediatrics, McMaster Children's Hospital, McMaster University, Department of Paediatrics, William Osler Health System, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Quin Y Liu
- Division of Gastroenterology and Hepatology, Medicine and Pediatrics, Cedars-Sinai Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Patrick Bontems
- Division of Pediatrics, Department of Pediatric Gastroenterology, Queen Fabiola Children's University Hospital, ICBAS - Université Libre de Bruxelles, Brussels, Belgium
| | - Diana G Lerner
- Division of Pediatrics, Pediatric Gastroenterology, Hepatology and Nutrition, Children's of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Jorge Amil-Dias
- Pediatric Gastroenterology, Department of Pediatrics, Centro Hospitalar Universitário S. João, Porto, Portugal
| | - Robert E Kramer
- Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Children's Hospital of Colorado, University of Colorado, Aurora, CO, United States
| | - Anthony R Otley
- Gastroenterology & Nutrition, Department of Pediatrics, IWK Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Lusine Ambartsumyan
- Division of Gastroenterology and Hepatology, Seattle Children's Hospital, Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Veronik Connan
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Graham A McCreath
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mike A Thomson
- Department of Paediatric Gastroenterology, Sheffield Children's NHS Foundation Trust, Sheffield, South Yorkshire, United Kingdom
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9
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Shrestha S, Gowda R, Race H, Khan S, Bhaduri B. The utility and safety of paediatric endoscopy in a district general hospital in Southeast England. Eur J Pediatr 2022; 181:1959-1965. [PMID: 35091800 PMCID: PMC8797371 DOI: 10.1007/s00431-022-04393-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 01/20/2022] [Accepted: 01/22/2022] [Indexed: 01/15/2023]
Abstract
UNLABELLED This study was done to evaluate the appropriateness, diagnostic yield, and quality of paediatric gastrointestinal endoscopy in a large DGH with tertiary paediatric gastroenterology services. It was a retrospective cohort study of children who had at least one gastrointestinal endoscopy during 31 months (May 2018-Dec 2020) in a district general hospital in Southeast England. The participants were children (2-17 years). Two hundred ninety-three procedures were performed in total, 80% were diagnostic and 20% for surveillance. The median age was 12 years and 52.5% were males. Oesophago-gastro-duodenoscopy (OGD) corresponded to 79.5% of procedures, ileo-colonoscopy (IC) to 7.2% and the remaining had both procedures. The main diagnostic indication was persistent abdominal pain in 33.5% of cases, followed by suspected GORD (14.8%), recurrent vomiting (14.3%), dysphagia (9.1%) and blood loss per rectum (8.6%). A total of 64.7% showed abnormal macroscopic findings, and 69.2% showed histopathological signs of disease. The most common histological diagnosis was gastritis in 23% followed by coeliac disease in 13%, reflux oesophagitis in 12.2% and inflammatory bowel disease in 9.6%. Procedures were performed with utmost safety with two reported cases of complications, which were appropriately managed. The completion rate of diagnostic IC was 87%. A waiting time of 6 weeks was achieved in 50.4% of cases. CONCLUSION Paediatric endoscopy can be safely performed in a district general hospital with the right setup and can aid in the management of gastrointestinal disease in the paediatric patient. It is important to monitor and regularly audit such practices to improve the quality of specialist services. WHAT IS KNOWN • Paediatric endoscopy is predominantly performed in large tertiary centres and included in the diagnostic algorithm for many paediatric gastrointestinal conditions. • There are recommendations on clinical indication endorsed by ESPGHAN and key quality indicators published jointly by JAG and BSPGHAN. WHAT IS NEW • Paediatric endoscopy can be appropriately and safely performed in district general hospital by trained professionals, decreasing the workload in larger tertiary paediatric centres. • Adoption of regular audit practices is essential to ensure and improve quality and appropriateness of this specialist service.
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Affiliation(s)
- Sudeep Shrestha
- Paediatric Department, Maidstone and Tunbridge Wells Hospital NHS Trust, Tunbridge Wells, TN2 4QJ Tonbridge Rd UK
| | - Rohit Gowda
- Paediatric Department, Maidstone and Tunbridge Wells Hospital NHS Trust, Tunbridge Wells, TN2 4QJ Tonbridge Rd UK
| | - Hermione Race
- Paediatric Department, Maidstone and Tunbridge Wells Hospital NHS Trust, Tunbridge Wells, TN2 4QJ Tonbridge Rd UK
| | - Shehriyar Khan
- Paediatric Department, Maidstone and Tunbridge Wells Hospital NHS Trust, Tunbridge Wells, TN2 4QJ Tonbridge Rd UK
| | - Bim Bhaduri
- Paediatric Department, Maidstone and Tunbridge Wells Hospital NHS Trust, Tunbridge Wells, TN2 4QJ Tonbridge Rd UK
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Ali KM, Zalata KR, Barakat T. Histopathologic ─ Endoscopic Concordance of Pediatric Duodenal Biopsy; How to Be Improved? Fetal Pediatr Pathol 2021; 40:395-406. [PMID: 31984824 DOI: 10.1080/15513815.2020.1716902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Few studies have correlated pediatric endoscopic and histologic impressions of duodenal biopsies. Method: This is a retrospective study on children undergoing upper gastrointestinal endoscopy over a period of 11 years. We investigated concordance between the gross endoscopic and histopathologic characteristics of pediatric duodenal biopsies. Results: Of 1793 children enrolled in the study, duodenal pathology was observed in 72.3%. The gross endoscopic findings showed a low sensitivity of 38.9%, specificity of 99.2%, PPV of 99.2%, and NPV of 38.3%. Concordance between the gross endoscopic and histopathologic analysis was 55.6%. Conclusion: This study showed a higher rate of pediatric duodenal pathologies than gross assessment. This emphasizes the value for acquiring routine duodenal biopsies from grossly normal mucosa.
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Affiliation(s)
- Khadiga Mohamed Ali
- Faculty of Medicine, Department of Pathology, Mansoura University, Mansoura, Egypt
| | | | - Tarik Barakat
- Mansoura University Children's Hospital, Mansoura, Egypt
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11
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Gastrointestinal endoscopy in children and adults: How do they differ? Dig Liver Dis 2021; 53:697-705. [PMID: 33692010 DOI: 10.1016/j.dld.2021.02.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 02/17/2021] [Accepted: 02/17/2021] [Indexed: 12/11/2022]
Abstract
Gastrointestinal endoscopy has grown dramatically over the past century, and with subsequent improvements in technology and anaesthesia, it has become a safe and useful tool for evaluation of GI pathology in children. There are substantial differences between paediatric and adult endoscopy beyond size, including: age-related patho-physiology and the different spectrum of diseases in children. Literature on endoscopic procedures in children is sparse but significant. The present review aims at describing the current knowledges on paediatric endoscopy practice and highlights the main areas of differences between paediatric and adult practice.
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12
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Altamimi E, Odeh Y, Al-Quraan T, Mohamed E, Rawabdeh N. Diagnostic yield and appropriate indication of upper endoscopy in Jordanian children. BMC Pediatr 2021; 21:10. [PMID: 33402143 PMCID: PMC7784337 DOI: 10.1186/s12887-020-02470-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 12/14/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Upper endoscopy is an essential tool for diagnosing pediatric gastrointestinal issues. This study aimed to assess the indications, diagnostic yields, concordance between histopathological and endoscopic findings and suitability of upper endoscopies performed at a tertiary university hospital in Jordan. METHODS Hospital records of children who underwent upper endoscopy were retrospectively reviewed. Demographics, endoscopic details (e.g., indications, findings and any complications), and histopathological findings were collected. The relationship between endoscopic findings and histopathological abnormalities was reported. RESULTS The study included 778 patients (age, 92.5 ± 54.5 months; 380 girls, 48.8%). The most common age group was children younger than 60 months (273 patients, 34.3%). The most common indication for endoscopy was abdominal pain, followed by vomiting and failure to thrive or weight loss. Normal upper endoscopy was reported in 411 patients (52.8%). Age below 60 months, abdominal pain, dysphagia/odynophagia, and heartburn were predictive of abnormal endoscopy in multivariate analysis with p-value 0.000, 0.048, 0.001 and 0.01 respectively. Abnormal endoscopy showed 67.3% sensitivity and 69.9% specificity to predict histopathological abnormalities. Of those performed, 13.6% endoscopies were described as inappropriate indication. The suitability of the procedure was a sensitive predictor for abnormal endoscopic and histopathological findings. CONCLUSIONS Abdominal pain is the most common indication for upper endoscopy in our population. It is associated with a higher chance of abnormal endoscopy. Concordance between endoscopic and histopathological findings is not high. Normal endoscopic findings shouldn`t discourage the endoscopist from obtaining tissue biopsies. Considering more biopsies may improve pathological detection rates. Compliance with established endoscopy guidelines may reduce unnecessary procedures.
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Affiliation(s)
- Eyad Altamimi
- Pediatric Department, Faculty of Medicine, Jordan University of Science and Technology, P.O.Box. 3030 , Postal code: 22110, Irbid, Jordan. .,Pediatric Department, King Abdullah University Hospital, Ar Ramtha, Jordan.
| | - Yousef Odeh
- Pediatric Department, Faculty of Medicine, Jordan University of Science and Technology, P.O.Box. 3030 , Postal code: 22110, Irbid, Jordan
| | - Tuka Al-Quraan
- Pediatric Department, Faculty of Medicine, Jordan University of Science and Technology, P.O.Box. 3030 , Postal code: 22110, Irbid, Jordan
| | - Elmi Mohamed
- Pediatric Department, Faculty of Medicine, Jordan University of Science and Technology, P.O.Box. 3030 , Postal code: 22110, Irbid, Jordan
| | - Naif Rawabdeh
- Pediatric Department, King Abdullah University Hospital, Ar Ramtha, Jordan
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de Oliveira FAB, Mazo DF. Direct access endoscopy in a Brazilian public healthcare facility: comparable results with specialist referred endoscopy. Scand J Gastroenterol 2020; 55:970-975. [PMID: 32619367 DOI: 10.1080/00365521.2020.1787500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Direct access endoscopy (DAE) is the procedure performed without the pre-evaluation of the patient by a specialist. It is widely available in many medical services around the world, but there is lack of data about this strategy in the setting of the public health system in Brazil. Therefore, the aim of this study is to compare the main endoscopic findings of upper gastrointestinal endoscopy requested through DAE and by specialists. METHODS Longitudinal, retrospective single center study in patients who underwent upper digestive endoscopy in a public healthcare facility at the southern region of the state of Mato Grosso, Brazil, from August 2011 to December 2018. Age, gender, modality of endoscopy request (DAE or endoscopy requested by specialists), and endoscopic findings were analyzed. RESULTS A total of 2810 patients were included. Most of them were female 65.23% (1833), mean age was 47.36 years, and 50.71% of the exams (1425) were DAE. Only 4.62% of the exams had normal reports. The most frequent endoscopic findings were gastritis (91.99%), bulboduodenitis (43.59%) and reflux esophagitis (14.76%). Patients who underwent endoscopy requested by specialists were older (50.25 ± 16.57 vs. 44.55 ± 16.31 years, p < .0001) and more frequently men (36.61 vs. 32.98%, p = .0437) in comparison to DAE. However, endoscopic findings were similar in both groups. CONCLUSION This study shows that direct access upper endoscopy had comparable results to specialist requested endoscopy in a public healthcare facility in the southern region of the state of Mato Grosso, Brazil.
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Affiliation(s)
- Fernando Augusto Borges de Oliveira
- School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil.,Medicine Course, Institute of Exact and Natural Sciences (ICEN), Federal University of Rondonópolis (UFR), Rondonópolis, Brazil
| | - Daniel F Mazo
- Division of Gastroenterology (Gastrocentro), School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil.,Division of Clinical Gastroenterology and Hepatology, Department of Gastroenterology, University of São Paulo School of Medicine (FMUSP), Sao Paulo, Brazil
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Wani MA, Zargar SA, Yatoo GN, Haq I, Shah A, Sodhi JS, Gulzar GM, Khan M. Endoscopic Yield, Appropriateness, and Complications of Pediatric Upper Gastrointestinal Endoscopy in an Adult Suite: A Retrospective Study of 822 Children. Clin Endosc 2020; 53:436-442. [PMID: 32252499 PMCID: PMC7403021 DOI: 10.5946/ce.2019.118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 10/17/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND/AIMS This study aimed to study the endoscopic yield, appropriateness, and complications of pediatric endoscopy performed by adult gastroenterologists in an adult endoscopic suite. METHODS This a retrospective study in which records of all the patients less than 18 years of age who underwent endoscopy in the last 5 years were studied. The indications of endoscopy in children were categorized as appropriate or inappropriate per the latest guidelines by American Society for Gastrointestinal Endoscopy and North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. Positive endoscopic yield was defined as the presence of any abnormality on endoscopy. RESULTS Among the total of 822 children (age <18 years), the most common indications were variceal surveillance/eradication in 157 (19.1%), followed by dyspepsia in 143 (17.4%), upper gastrointestinal (UGI) bleeding in 136 (16.5%), recurrent abdominal pain in 94 (11.4%), unexplained anemia in 74 (9%), recurrent vomiting in 50 (6.08%), chronic refractory gastroesophageal reflux disease in 34 (4.1%) and others; 780 out of 822 endoscopic procedures (94.9%) done in children were appropriate as per the guidelines. The endoscopic yield was 45.8%, highest in patients with UGI bleeding (71.3%), followed by variceal surveillance (54.8%), recurrent vomiting (38%), dyspepsia (37.8%), and recurrent abdominal pain (36%). Minor adverse events occurred in 7.3% of children. CONCLUSION Pediatric endoscopy performed by an experienced adult gastroenterologist may be acceptable if done in cooperation with a pediatrician.
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Affiliation(s)
- Manzoor Ahmad Wani
- Department of Gastroenterology and Hepatology, Jawahar Lal Nehru Memorial Hospital (JLNMH), Srinagar, India
| | - Showkat Ali Zargar
- Department of Gastroenterology and Hepatology, Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, India
| | - Ghulam Nabi Yatoo
- Department of Gastroenterology and Hepatology, Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, India
| | - Inaamul Haq
- Department of Community Medicine, Government Medical College (GMC) Srinagar, Srinagar, India
| | - Altaf Shah
- Department of Gastroenterology and Hepatology, Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, India
| | - Jaswinder Singh Sodhi
- Department of Gastroenterology and Hepatology, Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, India
| | - Ghulam Mohammad Gulzar
- Department of Gastroenterology and Hepatology, Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, India
| | - Mushtaq Khan
- Department of Gastroenterology and Hepatology, Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, India
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Repo M, Rajalahti T, Hiltunen P, Sotka A, Kivelä L, Huhtala H, Kaukinen K, Lindfors K, Kurppa K. Diagnostic findings and long-term prognosis in children with anemia undergoing GI endoscopies. Gastrointest Endosc 2020; 91:1272-1281.e2. [PMID: 31917169 DOI: 10.1016/j.gie.2019.12.042] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 12/22/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Intestinal diseases are regarded as a common cause of anemia, but the diagnostic outcomes of children with anemia undergoing endoscopic investigations are unclear. We investigated this issue in a large cohort of children. METHODS Indications for and findings of consecutive gastrointestinal (GI) endoscopies were collected. Clinical presentation and diagnostic outcomes were compared between anemic and nonanemic patients and between anemic patients with and without a diagnosis. Diagnoses received during follow-up were collected. RESULTS Of 2395 consecutive endoscopies, 251 children with and 613 children without anemia had undergone either diagnostic esophagogastroduodenoscopy (EGD) (51.4% and 51.4%, respectively), colonoscopy (4.0% and 11.4%), or both (45.8% and 37.8%). Children with anemia more often received diagnoses (72.9% vs 39.3%; odds ratio [OR], 4.18; 95% confidence interval [CI], 3.03-5.77), particularly of celiac disease (26.3% vs 15.5%, P < .001) and of inflammatory bowel disease (31.1% vs 9.1%, P < .001), than did nonanemic children. The diagnosis in anemic patients was predicted by age 5 to 12 years (OR, 3.52; 95% CI, 1.27-9.75), presence of diarrhea (OR, 2.04; 95% CI, 1.07-3.90), melena/hematochezia (OR, 2.40; 95% CI, 1.17-4.92), poor growth (OR, 3.94; 95% CI, 1.70-9.15), positive celiac serology (OR, 11.81; 95% CI, 3.47-40.12), high calprotectin (OR, 12.86; 95% CI, 4.00-41.32), hypersedimentation (OR, 2.65; 95% CI, 1.29-5.44), and hypoalbuminemia (OR, 5.05; 95% CI, 1.56-16.34). Thirty children with anemia (12.0%) had no GI symptoms, and 22 of them (73.3%) were given diagnoses at the time of the endoscopies. All 22 had additional laboratory abnormalities, whereas these were present in only 2 of 8 undiagnosed children. None of them was diagnosed later in the follow-up of up to 11 years, in contrast to 4 (6.7%) of all anemic and 33 (8.9%) of all nonanemic patients. CONCLUSIONS Anemia increased the probability of being given a diagnosis, emphasizing its importance as an alarm symptom. However, endoscopies in anemic patients without additional symptoms or laboratory abnormalities seldom improved the diagnostic yield.
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Affiliation(s)
- Marleena Repo
- Tampere Centre for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Finland; Department of Pediatrics, Tampere University Hospital, Tampere, Finland; Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Finland
| | - Teemu Rajalahti
- Tampere Centre for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Finland; Department of Pediatrics, Tampere University Hospital, Tampere, Finland
| | - Pauliina Hiltunen
- Tampere Centre for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Finland; Department of Pediatrics, Tampere University Hospital, Tampere, Finland
| | - Antti Sotka
- Department of Pediatrics, South Karelia Central Hospital, Lappeenranta, Finland
| | - Laura Kivelä
- Tampere Centre for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Finland; University of Helsinki and Helsinki University Hospital, Children's Hospital, and Pediatric Research Center, Helsinki, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Katri Kaukinen
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Finland; Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Katri Lindfors
- Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Finland
| | - Kalle Kurppa
- Tampere Centre for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Finland; Department of Pediatrics, Tampere University Hospital, Tampere, Finland; The University Consortium of Seinäjoki, Seinäjoki, Finland
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Silva S, Silva C, Espinheira MDC, Pais IP, Trindade E, Amil Dias J. Diagnostic Yield of Endoscopic Procedures in Children: Experience of a Portuguese Center. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2020; 27:404-409. [PMID: 33251289 DOI: 10.1159/000507207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 12/27/2019] [Indexed: 01/15/2023]
Abstract
Background Over the last decades, the use of gastrointestinal (GI) endoscopic procedures has been increased in children worldwide, allowing the early diagnosis and therapeutic intervention in multiple GI diseases. Aims and Methods In order to evaluate the appropriateness and the diagnostic yield of initial GI endoscopic techniques in children in a Portuguese tertiary hospital, we performed a retrospective cohort study during a 12-month period. Results A total of 308 procedures were performed in 276 patients; the median age was 11 years and 50.4% were males. Esophago-gastro-duodenoscopy (EGD) corresponded to 81.8% of the procedures and ileo-colonoscopy (IC) to the remaining; 11.6% of the patients underwent both EGD and IC. Overall, 51.3% of the exams showed abnormal macroscopic findings, and 69.6% showed histopathological signs of disease, with IC showing significantly more positive results than EGD (p < 0.05). Considering the different indications independently, abnormal serology for celiac disease, suspected ingestion of foreign bodies, suspected inflammatory bowel disease, and food impaction were frequent in our population; and in the majority of the cases, the suspected diagnosis was confirmed: celiac disease, ingestion of foreign bodies, inflammatory bowel disease, and eosinophilic esophagitis, respectively. On the other hand, despite the high frequency of epigastric pain in this population, only nearly one-third of the patients showed abnormal histological findings. The final diagnosis was established in 63% of the patients, and 39.1% initiated the new treatment. Discussion Our results emphasize the importance of endoscopic procedures, especially IC, in the diagnosis of GI diseases in pediatric patients, as well as the careful choice of the endoscopic techniques in those with less specific symptoms, as chronic abdominal pain. In this particular situation, given the proportion of cases that may be due to functional disease, good characterization of the clinical context is needed, and endoscopy should be reserved for a second-line approach. Conclusion It is important to monitor and examine the endoscopic techniques as an index of quality criteria for clinical practice.
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Affiliation(s)
- Sónia Silva
- Department of Pediatrics, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Cláudia Silva
- Department of Pediatrics, Centro Hospitalar Universitário de São João, Porto, Portugal
| | | | - Isabel Pinto Pais
- Department of Pediatrics, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Eunice Trindade
- Department of Pediatrics, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Jorge Amil Dias
- Department of Pediatrics, Centro Hospitalar Universitário de São João, Porto, Portugal
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Helin N, Kolho K, Rintala R, Merras‐Salmio L. Upper endoscopy for non-acute non-specific symptoms is seldom beneficial for children under the age of seven. Acta Paediatr 2020; 109:827-835. [PMID: 31538356 DOI: 10.1111/apa.15027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 08/15/2019] [Accepted: 09/17/2019] [Indexed: 12/17/2022]
Abstract
AIM This study estimated the diagnostic yield of oesophagogastroduodenoscopy (OGD) in young children with non-acute, non-specific gastrointestinal or respiratory symptoms who were treated by a Finnish tertiary level referral centre. METHODS A retrospective chart analysis was performed on 1850 Finnish children under 7 years of age who underwent their first diagnostic OGDs at Helsinki University Hospital during 2006-2016. We noted the endoscopy indications, macroscopic findings, the histology of the mucosal biopsies and the follow-up data. RESULTS After the exclusion criteria were applied, we enrolled 666 patients (57.7% boys) at a median age of 3.5 years. The number of children with non-specific symptoms referred for OGD increased 2.3-fold in 11 years. A routine set of biopsies was obtained in 644/666 (96.7%) of the endoscopies. The OGD was both macroscopically and histologically normal in 519/644 (80.6%) of cases. The most common indication was to rule out gastro-oesophageal reflux disease in 268/666 (40.2%) cases, and the most frequent histological diagnosis was mild to moderate oesophagitis in 57/644 (8.9%) cases. There was no erosive oesophagitis. CONCLUSION The diagnostic yield of macroscopic and histological OGD findings was low in our cohort. Unless there are alarming symptoms, younger children do not need OGD.
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Affiliation(s)
- Noora Helin
- Department of Paediatrics Children’s Hospital Paediatric Research Centre University of Helsinki Helsinki University Hospital Helsinki Finland
| | - Kaija‐Leena Kolho
- Department of Paediatrics Tampere University Hospital University of Helsinki Helsinki Finland
| | - Risto Rintala
- Department of Paediatric Surgery Paediatric Research Centre Helsinki University Hospital University of Helsinki Helsinki Finland
| | - Laura Merras‐Salmio
- Department of Paediatrics Children’s Hospital Paediatric Research Centre University of Helsinki Helsinki University Hospital Helsinki Finland
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Abstract
Optimal management of pediatric endoscopy requires a multidisciplinary approach. In most hospitals, endoscopy in pediatric patients is performed by conventional gastroenterologists and only a few centers have specialized pediatric gastroenterologists. This is due to the fact that the number of pediatric gastroenterologists is limited and not all of them are experienced in endoscopic techniques. However, there are also some pediatric centers offering a high-quality and high-volume endoscopy service provided by very experienced pediatric gastroenterologists. Up to now, the literature on pediatric endoscopy is rather sparse. In this article, we describe current knowledge and practice of endoscopic procedures in pediatric patients, which should be relevant for both the adult and pediatric gastroenterologists.
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Llanos-Chea A, Saps M. Utility of Diagnostic Tests in Children With Functional Abdominal Pain Disorders. Gastroenterol Hepatol (N Y) 2019; 15:414-422. [PMID: 31592242 PMCID: PMC6771033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Functional gastrointestinal disorders (FGIDs) and functional abdominal pain disorders (FAPDs) are common in pediatric patients. The prevalence of FGIDs using the Rome IV criteria ranges from 21.1% to 25.0% in children. The Rome IV criteria specify that the decision of testing is left to the clinician, giving him or her freedom to decide on the necessary workup. The clinician should consider all of the functional and organic diseases that manifest with chronic abdominal pain, as well as alarm features that should prompt testing. Societal guidelines and reports do not recommend routine evaluations for FAPDs, particularly in the absence of alarm features. Studies have reported variable results upon assessing the diagnostic yields of different tests. Furthermore, these evaluations considerably increase costs for the health care system. This article examines the current evidence on the utility of diagnostic testing in pediatric patients with FAPDs.
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Affiliation(s)
- Alejandro Llanos-Chea
- Dr Llanos-Chea is an assistant professor of pediatrics and Dr Saps is a professor of pediatrics in the Division of Pediatric Gastroenterology, Hepatology, and Nutrition at the Miller School of Medicine at the University of Miami in Miami, Florida
| | - Miguel Saps
- Dr Llanos-Chea is an assistant professor of pediatrics and Dr Saps is a professor of pediatrics in the Division of Pediatric Gastroenterology, Hepatology, and Nutrition at the Miller School of Medicine at the University of Miami in Miami, Florida
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The Evolving Role of Mucosal Histology in the Evaluation of Pediatric Functional Dyspepsia: A Review. GASTROINTESTINAL DISORDERS 2019. [DOI: 10.3390/gidisord1010013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Although not required to establish the diagnosis, endoscopy with mucosal biopsy is commonly performed in the evaluation of children with dyspepsia. Traditionally, esophagogastroduodenoscopy (EGD) has been performed in children with abdominal pain to identify pathology or conversely, to “rule-out” organic disease in order to establish a diagnosis of FD. In this review, we discuss the current diagnostic yield of endoscopically-obtained biopsies in identifying disease in children and adolescents with dyspepsia including an expanded discussion of common histologic diagnoses where clinical significance has not been definitively established. In turn, we discuss the transition of endoscopy from a search for disease to a search for biologic contributors to symptom generation, while considering the growing evidence linking non-diagnostic mucosal inflammation to FD, specifically mast cells and eosinophils.
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Reedy RA, Filipp SL, Gurka MJ, Shenoy A, Davis MK. Utility of Esophagogastroduodenoscopy in the Evaluation of Uncomplicated Abdominal Pain in Children. Glob Pediatr Health 2019; 6:2333794X19898345. [PMID: 35211650 PMCID: PMC8862188 DOI: 10.1177/2333794x19898345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 11/25/2019] [Accepted: 12/09/2019] [Indexed: 11/27/2022] Open
Abstract
Esophagogastroduodenoscopy (EGD) is commonly performed for abdominal pain in children, and in the presence of alarm symptoms, the diagnostic yield of this procedure is high. The aim of this study was to investigate the utility of EGD when performed for uncomplicated abdominal pain in children in the absence of alarm symptoms. Charts of all children less than 18 years of age who underwent EGD at the University of Florida between January 2016 and October 2018 were reviewed. Of 1478 children who underwent EGD for any indication, 287 patients (male-to-female = 123:164) were discovered to have undergone EGD, in the absence of colonoscopy, for uncomplicated acute or chronic abdominal pain, nausea, vomiting, gastroesophageal reflux, and/or dyspepsia, with no alarm symptoms. A significant change in clinical management was noted in 20 (7.0%) children. The findings of this procedure changed clinical management in a minority of our study participants.
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Mark JA, Campbell K, Gao D, Kramer RE. Algorithm to Predict Which Children With Chronic Abdominal Pain Are Low Suspicion for Significant Endoscopic Findings. Clin Pediatr (Phila) 2019; 58:79-87. [PMID: 30306797 DOI: 10.1177/0009922818806317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Chronic abdominal pain (CAP) is a common and challenging problem in pediatric primary and specialty care. We developed a diagnostic algorithm to organize workup for gastrointestinal causes of CAP and improve identification of patients who are low suspicion (LS) or high suspicion (HS) to have significant intestinal pathology identified with endoscopy. We retrospectively used this algorithm to categorize 150 outpatients with CAP as LS (n = 99) or HS (n = 51) and examined subsequent endoscopic findings for all patients. There were 6% significant diagnoses in the LS group compared with 34% in the HS group ( P < .0001). The LS group had no patients with celiac or inflammatory bowel disease. These results can be used to help a clinician approach CAP, and discuss with families the likelihood of endoscopy finding a cause for CAP based on LS or HS designation.
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Affiliation(s)
- Jacob A Mark
- 1 Children's Hospital Colorado, Aurora, CO, USA.,2 University of Colorado Denver School of Medicine, Aurora, CO, USA
| | - Kristen Campbell
- 3 University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Dexiang Gao
- 3 University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Robert E Kramer
- 1 Children's Hospital Colorado, Aurora, CO, USA.,2 University of Colorado Denver School of Medicine, Aurora, CO, USA
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DeBoer EM, Kinder S, Duggar A, Prager JD, Soden J, Deterding RR, Ruiz AG, Jensen EL, Weinman J, Wine T, Fortunato JE, Friedlander JA. Evaluating the yield of gastrointestinal testing in pediatric patients in aerodigestive clinic. Pediatr Pulmonol 2018; 53:1517-1524. [PMID: 30288952 DOI: 10.1002/ppul.24170] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 07/30/2018] [Accepted: 09/05/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To improve understanding of the interrelatedness of airway and esophageal diagnoses by evaluating the yield of procedural and radiographic testing of the gastrointestinal tract in children with airway conditions by their referring diagnoses in a pediatric aerodigestive clinic. METHODS A retrospective chart review of all 325 patients seen in the aerodigestive program from 2010 to 2013 was performed in a single academic medical center. Demographics and results from esophagogastroduodenoscopies with biopsies (EGD), upper gastrointestinal fluoroscopy studies (UGI), and pH multichannel intraluminal impedance probe (pH-MII) performed within 30 days of the clinic visit were evaluated according to presenting diagnoses. RESULTS Mean patient age was 3.15 years (range 0.15-24 years) and 41.2% were born premature. 189/325 (58.1%) were on acid suppression. A total of 295 EGD, 193 pH-MII, and 54 UGI were performed. The most common diagnosis with an abnormal pH-MII was asthma. The most common diagnoses with an abnormal EGD were feeding difficulty and tracheal esophageal fistula/ esophageal atresia (TEF/EA). EGDs were normal in 188/295 (63.7%), while 39/295 (13.2%) demonstrated esophagitis, and 22/295 (7.5%) had >15 esophageal eosinophils per high power field. The majority of pH-MII (144/193 [74.6%]) and UGI (47/54 [87%]) were normal. CONCLUSIONS Children with feeding difficulty, TEF/EA, and asthma were the mostly likely to have a histologic abnormality on EGD or an abnormal pH-MII. The majority of children were previously prescribed acid suppression medication and had a referring diagnosis of gastroesophageal reflux disease but were subsequently found to have normal evaluation. Prospective studies are needed to optimize care of this population.
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Affiliation(s)
- Emily M DeBoer
- Breathing Institute, Children's Hospital Colorado, Aurora, Colorado.,University of Colorado School of Medicine, Department of Pediatrics, Aurora, Colorado.,Aerodigestive Program, Children's Hospital Colorado, Aurora, Colorado
| | - Sarah Kinder
- University of Colorado School of Medicine, Department of Pediatrics, Aurora, Colorado.,Digestive Health Institute, Children's Hospital Colorado, Aurora, Colorado
| | - Alison Duggar
- University of Colorado School of Medicine, Department of Pediatrics, Aurora, Colorado
| | - Jeremy D Prager
- Aerodigestive Program, Children's Hospital Colorado, Aurora, Colorado.,University of Colorado School of Medicine, Department of Otolaryngology, Aurora, Colorado
| | - Jason Soden
- University of Colorado School of Medicine, Department of Pediatrics, Aurora, Colorado.,Aerodigestive Program, Children's Hospital Colorado, Aurora, Colorado.,Digestive Health Institute, Children's Hospital Colorado, Aurora, Colorado
| | - Robin R Deterding
- Breathing Institute, Children's Hospital Colorado, Aurora, Colorado.,University of Colorado School of Medicine, Department of Pediatrics, Aurora, Colorado.,Aerodigestive Program, Children's Hospital Colorado, Aurora, Colorado
| | - Amanda G Ruiz
- University of Colorado School of Medicine, Department of Otolaryngology, Aurora, Colorado
| | - Emily L Jensen
- University of Colorado School of Medicine, Department of Otolaryngology, Aurora, Colorado
| | - Jason Weinman
- Children's Hospital Colorado, Department of Radiology, Aurora, Colorado
| | - Todd Wine
- Aerodigestive Program, Children's Hospital Colorado, Aurora, Colorado.,University of Colorado School of Medicine, Department of Otolaryngology, Aurora, Colorado
| | - John E Fortunato
- Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Joel A Friedlander
- University of Colorado School of Medicine, Department of Pediatrics, Aurora, Colorado.,Aerodigestive Program, Children's Hospital Colorado, Aurora, Colorado.,Digestive Health Institute, Children's Hospital Colorado, Aurora, Colorado
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Clinical Presentation and Outcomes of Diagnostic Endoscopy in Newly Presenting Children With Gastrointestinal Symptoms. J Pediatr Gastroenterol Nutr 2018; 66:876-881. [PMID: 29261528 DOI: 10.1097/mpg.0000000000001864] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Paediatric endoscopy is an important diagnostic tool; however, there is little published data to guide clinicians in selecting patients for endoscopy. This study aimed to evaluate a single centre's experience of newly presenting children focusing on presenting symptoms, investigations, and diagnostic yield. METHODS Clinical factors and endoscopic plus histological findings over a 6-month period were assessed. Only first diagnostic endoscopies were included. All biopsies were reviewed in a weekly histopathology multidisciplinary team meeting with a final agreed outcome. Abnormal histology was used as the criterion standard for reporting abnormality. RESULTS A total of 218 endoscopies were reviewed in 164 children. Approximately 65% were histologically normal (49% of children had macroscopically and histologically normal findings). Macroscopic and histological abnormalities (respectively) were 44% and 28% of oesophagogastroduodenoscopy (OGD) patients, 25% and 25% of colonoscopy alone, and 53% and 53% of those undergoing both OGD and colonoscopy (OGD&Col). For OGD-only patients, excluding those with raised anti-tissue transglutaminase antibodies, vomiting led to the highest rate of abnormal histology (22%). For colonoscopy-only and OGD&Col patients, per rectum bleeding led to the highest rates of abnormal histology (14% and 29%, respectively), after excluding those with laboratory abnormalities (anaemia and raised erythrocyte sedimentation rate) suggestive of inflammatory bowel disease. CONCLUSIONS This study showed that half of all first diagnostic endoscopies in our unit had neither macroscopic nor histological abnormalities. There was discrepancy between macroscopic abnormalities and histological findings in OGD. Prospective studies are needed to develop guidelines in appropriately predicting abnormality and selecting patients for endoscopy.
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Akbulut UE, Fidan S, Emeksiz HC, Ors OP. Duodenal pathologies in children: a single‐center experience. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2018. [DOI: 10.1016/j.jpedp.2017.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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26
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Akbulut UE, Fidan S, Emeksiz HC, Ors OP. Duodenal pathologies in children: a single-center experience. J Pediatr (Rio J) 2018; 94:273-278. [PMID: 28888898 DOI: 10.1016/j.jped.2017.06.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 04/14/2017] [Accepted: 04/17/2017] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE Several studies have been performed concerning pathologies of the stomach and esophagus in the pediatric age group. However, there have been very few studies of duodenal pathologies in children. The authors aimed to examine the clinical, endoscopic, and histopathological characteristics, as well as the etiology of duodenal pathologies in children. METHOD Patients aged between 1 and 17 years undergoing esophagogastroduodenoscopy during two years at this unit, were investigated retrospectively. Demographic, clinical, endoscopic data, and the presence of duodenal pathologies, gastritis, and esophagitis were recorded in all of the children. RESULTS Out of 747 children who underwent endoscopy, duodenal pathology was observed in 226 (30.3%) patients. Pathology was also present in the esophagus in 31.6% of patients and in the stomach in 58.4%. The level of chronic diarrhea was higher in patients with duodenal pathology when compared with those without duodenal pathology (p=0.002, OR: 3.91, 95% CI: 1.59-9.57). Helicobacter pylori infection was more common in patients with pathology in the duodenum (59.3%). CONCLUSION Duodenal pathology was detected in 30.3% of the present patients. A significantly higher level of chronic diarrhea was observed in subjects with duodenal pathologies compared to those with no such pathology. The rate of Helicobacter pylori infection was considerably higher than that in previous studies. In addition, there is a weak correlation between endoscopic appearance and histology of duodenitis.
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Affiliation(s)
- Ulas Emre Akbulut
- Kanuni Training and Research Hospital, Department of Pediatric Gastroenterology, Hepatology and Nutrition, Trabzon, Turkey.
| | - Sami Fidan
- Karadeniz Technical University, Faculty of Medicine, Department of Gastroenterology, Trabzon, Turkey
| | - Hamdi Cihan Emeksiz
- Kanuni Training and Research Hospital, Department of Pediatric Endocrinology, Trabzon, Turkey
| | - Orhan Polat Ors
- Istanbul Bilim University, Faculty of Medicine, Department of Anatomy, Istanbul, Turkey
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Pediatric Gastroesophageal Reflux Disease: Systematic Review on Prognosis and Prognostic Factors. J Pediatr Gastroenterol Nutr 2018; 66:239-243. [PMID: 28753185 DOI: 10.1097/mpg.0000000000001697] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
In this systematic review, we summarize the evidence on prognosis and prognostic factors of pediatric gastroesophageal reflux disease (GERD). A structured search of Embase and MEDLINE/PubMed (inception to April 2016) yielded 5365 references; 4 publications met our inclusion criteria (risk of bias moderate-high). Definitions and outcome measures varied widely between studies. The percentage of children with a diagnosis of GERD with esophagitis that had persisting symptoms and/or were on antireflux medication at follow-up (12 months to >5 years) ranged from 23% (weekly symptoms) to 68% (antireflux medication), depending on definition used. In children with a diagnosis of GERD without esophagitis, 1.4% developed esophagitis at follow-up (>5 years); none developed Barrett esophagus. In conclusion, prognostic studies on pediatric GERD are of limited quality and show large methodological heterogeneity. Based on these studies, we are unable to identify those children at risk for unfavorable outcome with regards to GERD symptoms or endoscopic complications.
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Akbulut UE, Emeksiz HC, Kocak FG, Livaoglu A. Diagnostic yield of esophagogastroduodenoscopy in children with chronic abdominal pain. Arch Med Sci 2018; 14:74-80. [PMID: 29379535 PMCID: PMC5778425 DOI: 10.5114/aoms.2017.67675] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 04/16/2017] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Chronic abdominal pain (CAP) is one of the most common indications of esophagogastroduodenoscopy (EGD) in the pediatric population. However, there is not enough information about the diagnostic yield of EGD in children with CAP. We aimed to evaluate the diagnostic yield of EGD in children with CAP in the Eastern Black Sea region of Turkey. MATERIAL AND METHODS The study included children (n = 372) who underwent EGD for the primary indication of chronic abdominal pain during an 18-month period. We collected data on demographic features (age, sex), clinical characteristics (alarm symptoms), and EGD results for each patient. RESULTS Patients' mean age was 13 years (range: 4-17 years; mean ± SD: 12.65 ±3.39 years), and the majority were female (n = 234, 62.9%). Endoscopy was diagnostic in 209 patients (56.2%; 95% CI: 30.35-40.05%). The most common diagnosis was Helicobacter pylori gastritis (35.2%) followed by reflux esophagitis. Significantly greater diagnostic yield of EGD was determined in patients with alarm symptoms (65.1%) compared to those without (45.2%) (OR = 2.26, 95% CI: 1.49-3.44, p = 0.001). CONCLUSIONS We determined a high diagnostic yield of EGD in children with CAP. Although the diagnostic yield of EGD in the assessment of CAP was found to be higher in the presence of alarm symptoms, a significant number of children without alarm symptoms were also found to have gastrointestinal system pathology diagnosed by EGD.
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Affiliation(s)
- Ulas Emre Akbulut
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Kanuni Training and Research Hospital, Trabzon, Turkey
| | - Hamdi Cihan Emeksiz
- Department of Pediatric Endocrinology and Diabetes, Kanuni Training and Research Hospital, Trabzon, Turkey
| | - Fatma Gulgun Kocak
- Department of Pathology, Kanuni Training and Research Hospital, Trabzon, Turkey
| | - Ayten Livaoglu
- Department of Pathology, Kanuni Training and Research Hospital, Trabzon, Turkey
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Lyons H, Zhang Y, Szpunar S, Dharmaraj R. Predictors of positive esophagogastroduodenoscopy outcomes in children and adolescents: a single center experience. BMC Res Notes 2017; 10:356. [PMID: 28754143 PMCID: PMC5534084 DOI: 10.1186/s13104-017-2693-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 07/26/2017] [Indexed: 01/09/2023] Open
Abstract
Background Esophagogastroduodenoscopy (EGD) has become a key element in the diagnosis and therapy of many gastrointestinal diseases affecting children. The aim of this study was to evaluate predictors of positive outcomes in children undergoing their first diagnostic EGD with biopsies at a single center. Results This retrospective study was based on findings from existing EGD and histopathological reports. All procedures were performed between July 2006 and July 2013. Details of each patient’s clinical presentation and EGD were abstracted from medical records to determine the predictors of positive EGD outcomes. A total of 1133 records of patients between the ages of 0 and 18 years old were evaluated. Of these patients, 51.5% (n = 573) were female and 24.5% (n = 278) were younger than 4 years old. The mean age at the time of EGD was 9.6 ± 5.7 years (mean ± standard deviation). The most common indications for the procedure were abdominal pain (54.9%) and emesis (31.9%). The overall prevalence of any endoscopic abnormality was 54.5% and the overall prevalence of any histological abnormality was 59.1%. A multivariate logistic regression found that patients 12 years or older (odds ratio, OR = 1.46; 95% confidence interval, CI 1.31–1.63), African–American race (OR = 2.20; 95% CI 1.45–3.34), dysphagia (OR = 1.96; 95% CI 1.28–3.00) and positive celiac antibodies (OR = 2.25; 95% CI 1.52–3.34) were all significant independent predictors of a positive EGD outcome. Conclusions Several clinical variables were found to be independent predictors of positive EGD outcomes in children and adolescents. Prospective studies using standardized definitions of clinical variables and endoscopy outcomes are needed to further understand predictors of positive EGDs.
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Affiliation(s)
- Hernando Lyons
- Department of Pediatric Gastroenterology, St. John Hospital and Medical Center, Wayne State University School of Medicine, Detroit, MI, 48236, USA
| | - Ying Zhang
- Department of Pediatrics, St. John Hospital and Medical Center, Detroit, MI, 48236, USA
| | - Susan Szpunar
- Department of Medical Education, St. John Hospital and Medical Center, Detroit, MI, 48236, USA
| | - Rajmohan Dharmaraj
- Department of Pediatric Gastroenterology, University of New Mexico, Albuquerque, NM, 87106, USA.
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Yu Y, Wang B, Yuan L, Yang H, Wang X, Xiao Y, Mei H, Xu C. Upper Gastrointestinal Bleeding in Chinese Children: A Multicenter 10-Year Retrospective Study. Clin Pediatr (Phila) 2016; 55:838-43. [PMID: 26467562 DOI: 10.1177/0009922815611642] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective This study aims to analyze the clinical and endoscopic presentations of upper gastrointestinal bleeding (UGIB) in the Chinese children. Methods A 10-year retrospective study was made on children with UGIB and undertaken esophagogastroduodenoscopy (EGD) from 4 tertiary referral centers in China. Results Of the 1218 children studied, the bleeding source was found in 76.4%. Erosive gastritis was the most common endoscopic finding (33.5%), followed by duodenal ulcer (23.2%). The proportion of erosive gastritis decreased with age (correlation coefficient = -0.787), and duodenal ulcer increased with age (correlation coefficient = 0.958). The bleeding source was more likely to be determined in children having EGDs within 48 hours (80.6% vs 67.9%). Conclusions In Chinese children with UGIB, erosive gastritis and duodenal ulcer were the leading causes, and their proportions varied with age. EGDs performed within 48 hours may improve the possibility of finding the source of bleeding.
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Affiliation(s)
- Yi Yu
- Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Baoxiang Wang
- Wuhan Women and Children Health Care Center, Shanghai, China
| | - Lan Yuan
- Chengdu Women's and Children's Central Hospital, Chengdu, China
| | - Hui Yang
- Nanjing Children's Hospital, Nanjing Medical University, Nanjing, China
| | - Xinqiong Wang
- Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuan Xiao
- Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hong Mei
- Wuhan Women and Children Health Care Center, Shanghai, China
| | - Chundi Xu
- Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Dubin SM, Kwong WT, Kalmaz D, Savides TJ. Low yield of routine duodenal biopsies for evaluation of abdominal pain. World J Gastroenterol 2015; 21:7495-9. [PMID: 26139995 PMCID: PMC4481444 DOI: 10.3748/wjg.v21.i24.7495] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 02/23/2015] [Accepted: 04/16/2015] [Indexed: 02/06/2023] Open
Abstract
AIM To determine the yield of biopsying normal duodenal mucosa for investigation of abdominal pain. METHODS This is a retrospective chart review of consecutive patients who underwent esophagogastroduodenoscopy (EGD) with duodenal biopsies of normal appearing duodenal mucosa for an indication that included abdominal pain. All the patients in this study were identified from an electronic endoscopy database at a single academic medical center and had an EGD with duodenal biopsies performed over a 4-year period. New diagnoses that were made as a direct result of duodenal biopsies were identified. All duodenal pathology reports and endoscopy records were reviewed for indications to perform the examination as well as the findings; all the medical records were reviewed. Exclusion criteria included age less than 18 years, duodenal mass, nodule, or polyp, endoscopic duodenitis, duodenal scalloping, known celiac disease, positive celiac serology, Crohns disease, or history of bone marrow transplant. Information was collected in a de-identified database with pertinent demographic information including human immunodeficiency virus (HIV) status, and descriptive statistics were performed. RESULTS About 300 patients underwent EGD with biopsies of benign appearing or normal appearing duodenal mucosa. The mean age of patients was 44.1 ± 16.8 years; 189 of 300 (63%) were female. A mean of 4.3 duodenal biopsies were performed in each patient. In the subgroup of patients with abdominal pain without anemia, diarrhea, or weight loss the mean age was 43.4 ± 16.3 years. Duodenal biopsies performed for an indication that included abdominal pain resulting in 4 new diagnoses (3 celiac disease and 1 giardiasis) for an overall yield of 1.3%. 183 patients with abdominal pain without anemia, diarrhea, or weight loss (out of the total 300 patients) underwent duodenal biopsy of duodenal mucosa resulting in three new diagnoses (two cases of celiac disease and one giardiasis) for a yield of 1.6%. Duodenal biopsies of 19 HIV patients presenting for evaluation of abdominal pain did not reveal any new diagnoses. Information pertaining to new diagnoses is provided. CONCLUSION Routine biopsy of normal appearing duodena in patients with abdominal pain should be reserved for those with a high pre-test probability given its low diagnostic yield.
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Gastroscopy in pediatric surgery: indications, complications, outcomes, and ethical aspects. Gastroenterol Res Pract 2015; 2015:820340. [PMID: 25883646 PMCID: PMC4389833 DOI: 10.1155/2015/820340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Revised: 03/11/2015] [Accepted: 03/12/2015] [Indexed: 11/17/2022] Open
Abstract
Background. The aim of this study was to map gastroscopies performed at a single tertiary pediatric surgery centre to investigate indications, complications, outcomes, and ethical aspects. Material and Methods. A retrospective study of gastroscopies performed during two time periods (2001-2004 and 2011-2014) was conducted. Data regarding indications, outcomes, and complications of pediatric gastroscopies were analysed from a prospectively collected database. Results. The indications for gastroscopies changed over time. Therefore, 376 gastroscopies performed from 2011 through 2014 were studied separately. The median patient was four years old. The predominant indications were laparoscopic gastrostomy (40%), investigation of gastroenterological conditions (22%), obstruction in the upper gastrointestinal tract (20%), gastroesophageal reflux disease (GERD) (15%), and other indications (3%). Percentages of gastroscopies with no positive findings for each condition were laparoscopic gastrostomy, 100%; gastroenterological conditions, 46%; obstruction in the upper gastrointestinal tract, 36%; GERD, 51%. Furthermore, gastroscopies did not lead to any further action or change in treatment in 45% of gastroenterological conditions and 72% of GERD cases. The overall complication rate was 1%. Conclusion. The results are valuable to educate pediatric surgeons and to inform health care planning when including gastroscopy within clinical practice.
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Reply: To PMID 24931509. Clin Gastroenterol Hepatol 2015; 13:410. [PMID: 25305351 DOI: 10.1016/j.cgh.2014.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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The concordance of endoscopic and histologic findings of 1000 pediatric EGDs. Gastrointest Endosc 2015; 81:1385-91. [PMID: 25440693 PMCID: PMC4833447 DOI: 10.1016/j.gie.2014.09.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 09/03/2014] [Indexed: 12/17/2022]
Abstract
BACKGROUND Pediatric gastroenterologists frequently perform routine endoscopic biopsies despite normal-appearing mucosa during EGD. Older small studies have supported this practice. OBJECTIVE To re-evaluate the concordance between endoscopic appearance and histology in the era of high-definition endoscopy. DESIGN Retrospective cohort study. SETTING Single tertiary care center. PATIENTS A total of 1000 pediatric patients undergoing initial EGD. MAIN OUTCOME MEASUREMENTS Endoscopic and histologic findings. RESULTS The overall rate of an endoscopic finding was 34.7%, which was 40.4% of a histologic finding. Concordance between the presence of any endoscopic finding and any histologic finding in all locations was 69.9% (Cohen's κ coefficient=0.32). In the esophagus, the concordance between any endoscopic finding and any histologic finding was 82.6% (κ=0.45). The stomach was 73.2% concordant (κ=0.18), and the duodenum was 89.3% concordant (κ=0.42). The κ coefficient decreased when comparing specific findings in each location; it was 0.34 in the esophagus, 0.17 in the stomach, and 0.34 in the duodenum. If biopsy specimens had only been obtained when the endoscopist identified abnormal mucosa, 48.5% of the pathologic findings would have been missed. In patients with histology consistent with eosinophilic esophagitis, 30.2% had normal-appearing mucosa. For celiac disease, 43% had normal-appearing mucosa. In the stomach, an abnormal endoscopic appearance was more likely to have normal histology. LIMITATIONS The single-center, retrospective nature and more endoscopists than pathologists. CONCLUSIONS These data support the routine collection of biopsy specimens in the duodenum, stomach, and esophagus during EGD in pediatric patients.
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