The concordance of endoscopic and histologic findings of 1000 pediatric EGDs

• Published in: Gastrointestinal endoscopy 2015-06, Vol.81 (6), p.1385-1391
• Main Authors: Sheiko, Melissa A., MD, Feinstein, James A., MD, MPH, Capocelli, Kelley E., MD, Kramer, Robert E., MD
• Format: Article
• Language: English
• Subjects: Adolescent; Biopsy - methods; Celiac Disease - diagnosis; Celiac Disease - pathology; Child; Child, Preschool; Cohort Studies; Duodenum - pathology; Endoscopy, Gastrointestinal - methods; Eosinophilic Esophagitis - diagnosis; Eosinophilic Esophagitis - pathology; Esophagus - pathology; Female; Gastroenterology and Hepatology; Humans; Infant; Male; Mucous Membrane - pathology; Retrospective Studies; Stomach - pathology; Stomach Diseases - diagnosis; Stomach Diseases - pathology
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2014.09.010

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.