Diagnostic yield of EGD in children: a retrospective single-center study of 1000 cases

• Published in: Gastrointestinal endoscopy 2013-07, Vol.78 (1), p.47-54.e1
• Main Authors: Sheiko, Melissa A., MD, Feinstein, James A., MD, MPH, Capocelli, Kelley E., MD, Kramer, Robert E., MD
• Format: Article
• Language: English
• Subjects: Abdominal Pain - diagnosis; Adolescent; Age Factors; Child; Child, Preschool; Cohort Studies; Endoscopes, Gastrointestinal; Endoscopy, Digestive System - methods; Endoscopy, Digestive System - utilization; Failure to Thrive - diagnosis; Female; Gastroenterology and Hepatology; Gastroesophageal Reflux - diagnosis; Gastrointestinal Diseases - diagnosis; Hospitals, Pediatric; Humans; Infant; Logistic Models; Male; Multivariate Analysis; Patient Safety; Retrospective Studies; Risk Assessment; Sex Factors; Tertiary Care Centers
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2013.03.168

Background Pediatric EGD is increasingly being used, but few studies have recently evaluated the diagnostic yield. Objective To assess the association between presenting clinical symptoms and the likelihood of significant endoscopic and histologic abnormalities for initial diagnostic endoscopy. Design Retrospective cohort study. Setting Large, tertiary care children's hospital. Patients One thousand patients, ages 1 month to 18 years, who underwent initial diagnostic EGD in 2009 and 2010. Interventions None. Main Outcome Measures Endoscopic and histologic abnormalities. Results The most common primary indications for endoscopy were generalized abdominal pain (28.7%), gastroesophageal reflux (11.7%), and failure to thrive (9.5%). The overall prevalence of an endoscopic abnormality was 34.7% and of a histologic abnormality, 40.4%. The highest rates of endoscopic abnormalities were found in patients with strictures on upper GI radiology (100%), foreign body (88%), and GI bleeding (57%). The highest rates of histologic abnormalities were in patients with positive celiac screening (91%), foreign body (88%), dysphagia (51%), and GI bleeding (49%), and the lowest rates of histologic abnormalities were miscellaneous indications (17%), strictures on radiology (25%), and reflux (26%). Females and patients < 1 year of age had lower rates of abnormal histologic abnormalities. Limitations Retrospective nature of the study, limitation to a single tertiary care center, and simplification of complex patient presentations to a single indication. Conclusions Rates of endoscopic and histologic abnormalities from EGD vary based on age and indication for endoscopy, and this should be factored into the decision to proceed with initial endoscopy along with consideration of adverse event rates and effects of anesthesia.