Endoscopic Yield, Appropriateness, and Complications of Pediatric Upper Gastrointestinal Endoscopy in an Adult Suite: A Retrospective Study of 822 Children

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. Conclusions: Pediatric endoscopy performed by an experienced adult gastroenterologist may be acceptable if done in cooperation with a pediatrician.

Safety and Competency are the Main Priorities in Pediatric Endoscopy

“…In this issue of Clinical Endoscopy, Wani et al demonstrated that pediatric endoscopy for children over 4 months of age was safely performed by adult gastroenterologists in conjunction with a pediatrician. 6 This finding is supportable in most of the countries where pediatric endoscopists are few. Furthermore, acknowledging the presence of a pediatric gastroenterologist, the collaboration of an adult gastroenterologist is vital for the optimal management of pediatric patients because adult endoscopists are capable of performing more complex endoscopic procedures (e.g., endoscopic retrograde cholangiopancreatography, endoscopic ultrasonography, and stent placement).…”

“…Authors from Kashmir, India, had reported 110 pediatric cases of therapeutic endoscopy (e.g., active bleeding control, variceal ligation, foreign body removal, etc.). 6 To comment from the standpoint of a pediatric gastroenterologist, I have some tips based on my experience and the Internet. Endoscopic variceal ligation (EVL) is often required for infants with advanced liver cirrhosis because of biliary atresia awaiting liver transplantation.…”

“…In this issue of Clinical Endoscopy , Wani et al demonstrated that pediatric endoscopy for children over 4 months of age was safely performed by adult gastroenterologists in conjunction with a pediatrician [ 6 ]. This finding is supportable in most of the countries where pediatric endoscopists are few.…”

“…Authors from Kashmir, India, had reported 110 pediatric cases of therapeutic endoscopy (e.g., active bleeding control, variceal ligation, foreign body removal, etc.) [ 6 ].…”

“…In this regard, it is essential that the adult gastroenterologist collaborates with a pediatrician. Wani et al provided meaningful data pertaining to pediatric diagnostic and therapeutic endoscopy [ 6 ]. It is important for both pediatric and nonpediatric endoscopists to be familiar with the pediatric guidelines that have already been developed [ 1 , 5 ].…”