Good Agreement Between Endoscopic Findings and Biopsy Reports Supports Limited Tissue Sampling During Pediatric Colonoscopy

Manfredi, Michael A.; Jiang, Hongyu; Borges, Lawrence F.; Deutsch, Amanda J.; Goldsmith, Jeffrey D.; Lightdale, Jenifer R.

doi:10.1097/mpg.0000000000000317

Cited by 19 publications

(23 citation statements)

References 12 publications

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“…Our study showed that 46 patients (12%) had isolated abdominal pain as the indication for colonoscopy. The lower diagnostic yield of 24% (15% EA, 9% IHA) in this subgroup is in agreement with prior studies [7,8,10,11,16]. However, an important limitation in this finding is the difficulty in identifying some less frequent coexisting indications in a retrospective review, including first degree relatives with IBD, need for fecal microbiota transplantation, and abnormal studies from outside institutions.…”

Section: Discussionsupporting

confidence: 90%

“…To our knowledge, variability by individual physicians in diagnostic yield and ileal intubation rate has not been reported in a large pediatric population previously. It is notable that our overall diagnostic yield of 48% is similar with other studies [7][8][9][10][11][12][13]. Manfredi et al [8] examined 390 colonoscopies performed by 26 different clinicians.…”

Section: Discussionsupporting

confidence: 86%

“…In our cohort, among patients with a normal colon, there were 21 (6%) with a grossly abnormal ileum and an additional 16 (4%) with abnormal histology in the ileum. Thus, > 10% of patients with a normal While the discrepancy between the gross appearance and histology is well-recognized with EGD [19][20][21], most reports from pediatric colonoscopy show good correlation between gross findings and histology [8][9][10]. In one study of 390 colonoscopies, there were 20 patients with abnormal histology with normal visual findings [8]; 8 of the 20 had a known diagnosis of IBD, 4 had symptoms highly suspicious for IBD, and another 3 patients were immunosuppressed due to either bone marrow transplant or nephrotic syndrome.…”

Section: Discussionmentioning

confidence: 99%

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Diagnostic Yield Variation with Colonoscopy among Pediatric Endoscopists

Hochman

Figueroa

Duner

et al. 2019

Dig Dis

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Background: The primary aim of our study was to determine provider variation in diagnostic yield in a pediatric endoscopy center. Secondary aims were to examine ileal intubation rates as well as procedural complications at the provider level. Methods: A retrospective review of sequential pediatric patients who underwent a colonoscopy, completed by June 2018, determined the rates of endoscopically abnormal (EA) and isolated histologically abnormal (IHA) colonoscopies; the overall diagnostic yield was the combination of EA and IHA. Results: In total, 374 charts were reviewed. This study found high variability in diagnostic yield among the 16 clinicians ranging from as low as 22% to as high as 86% (p = 0.11) with an overall diagnostic yield of 48% for colonoscopy; excluding follow-up colonoscopies, the diagnostic yield was 42%. Abnormal calprotectin and abnormal blood tests were associated with higher diagnostic yields of 83 and 65%, respectively, compared with symptoms such as abdominal pain, diarrhea, and rectal bleeding which had yields of 39, 43, and 61%. Ileal intubation rates averaged 90% (range 63-100%, p = 0.06). In patients with a normal colon, there were 21 (6%) patients with an EA ileum and an additional 16 (4%) with an IHA ileum. Prep quality was rated excellent, good, or average in 97%. In addition, there was a low rate of serious complications (1 of 374). Conclusions: This study highlights the individual variability in diagnostic yield and ileal intubation rates in a pediatric gastroenterology practice. Goals for pediatric endoscopy could include ileal intubation rates of > 90% and provider diagnostic yields of > 40%.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

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Diagnostic Yield Variation with Colonoscopy among Pediatric Endoscopists

Hochman

Figueroa

Duner

et al. 2019

Dig Dis

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“…The cancer prevalence is extremely low in the pediatric population while other diagnostic indications are similar. Many therapeutic procedures are age related; e.g., removing of hyperplastic polyps or juvenile polyps are very rare in children [35,36], the same is true for esophageal polyps [37]. Common indications in children are: Chronic diarrhea (51%), impaired growth (41%), therapy refractory reflux symptoms (27%), and rectal bleeding (9%) [38].…”

Section: Indications Of Pediatric Endoscopymentioning

confidence: 99%

Pediatric Endoscopy, Update 2020

et al. 2019

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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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“…So sind spezielle Indikationen im Kindesalter eine Rarität, wie z. B. eine Polypentfernung bei hyperplastischen Polypen, Ösophaguspolypen [21] und juvenilen Kolonpolypen [22,23]. So sind die Indikationen im ersten Lebensjahr chronischer Durchfall (51 %), Gedeihstörung (41 %), Refluxsymptomatik (27 %) und rektale Blutung 9 % [24].…”

Section: Indikationsspektrum Pädiatrischer Endoskopieunclassified

Pädiatrische Endoskopie – ein Update

Schreiber-Dietrich

Hocke

Gottschalk³

et al. 2016

Z Gastroenterol

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Pediatric endoscopy is a good example of a multidiscipliniary approach. In many, but not all hospitals, endoscopy in pediatric patients is performed by conventional gastroenterologists and only in some centers by pediatric gastroenterologists. This is due to the fact that not as many pediatric gastroenterologists are available. Some of the centers are very experienced. There is only limited literature on pediatric endoscopy available. Therefore, an update may be relevant for both the adult and pediatric gastroenterologists. Here we describe current knowledge on endoscopic procedures in pediatric patients.

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Good Agreement Between Endoscopic Findings and Biopsy Reports Supports Limited Tissue Sampling During Pediatric Colonoscopy

Cited by 19 publications

References 12 publications

Diagnostic Yield Variation with Colonoscopy among Pediatric Endoscopists

Diagnostic Yield Variation with Colonoscopy among Pediatric Endoscopists

Pediatric Endoscopy, Update 2020

Pädiatrische Endoskopie – ein Update

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