Diagnostic Yield of Endoscopic Procedures in Children: Experience of a Portuguese Center

Abstract

<b><i>Background:</i></b> 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. <b><i>Aims and Methods:</i></b> 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.<b><i> Results:</i></b>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 (<i>p</i> < 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.<b><i> Discussion:</i></b>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. <b><i>Conclusion:</i></b> It is important to monitor and examine the endoscopic techniques as an index of quality criteria for clinical practice.

Indications and Yield of Pediatric Endoscopy in Bahrain: A Tertiary Center Experience

“…In fact, we were not satisfied that CAP, which is mostly functional, forms 40.9% of the indications of endoscopic procedures performed for children in our center. Like other studies, this finding can be attributed to the choice of the “line of least resistance” by the treating physician or to the fear of the child's parents/guardians of missinga diagnosis of a life-threating condition like cancer, which is extremely rare in children undertaking UGIE and prompts them to seek unnecessary testing [ 25 , 31 ]. Yet, Silva et al looked at this point from the positive side considering performing UGIE as a therapeutic tool besides being a method to exclude other differential diagnosis [ 31 ].…”

“…Like other studies, this finding can be attributed to the choice of the “line of least resistance” by the treating physician or to the fear of the child's parents/guardians of missinga diagnosis of a life-threating condition like cancer, which is extremely rare in children undertaking UGIE and prompts them to seek unnecessary testing [ 25 , 31 ]. Yet, Silva et al looked at this point from the positive side considering performing UGIE as a therapeutic tool besides being a method to exclude other differential diagnosis [ 31 ]. They claimed that performing endoscopy in children with CAP can stop the cycle of fear by showing the children and their parents that there is no structural problem causing these pains [ 31 ].…”

“…Nonetheless, Ahmad et al and Ataee et al reported a higher percentage of CAP of 53% and 97.5%, respectively [ 11 , 30 ]. This might be attributed to many patients with functional abdominal pain that have been over-investigated with endoscopic procedures [ 25 , 31 ]. Out of 451 patients presented with CAP in our study, 200 (44.4%) had a final diagnosis as functional abdominal pain, and they had normal endoscopic findings.…”

“…Yet, Silva et al looked at this point from the positive side considering performing UGIE as a therapeutic tool besides being a method to exclude other differential diagnosis [ 31 ]. They claimed that performing endoscopy in children with CAP can stop the cycle of fear by showing the children and their parents that there is no structural problem causing these pains [ 31 ]. We might disagree with this argument.…”

Carbon Dioxide vs. Air Insufflation for Pediatric Gastrointestinal Endoscopy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…Pediatric patients routinely undergo EGD or colonoscopy as a diagnostic or therapeutic procedure ( 10 – 14 ). However, with continuous research, the indications for EGD or colonoscopy in pediatric patients is constantly evolving.…”