Diagnostic Yield of Endoscopy in Upper Gastrointestinal Bleeding in Pediatrics

Abstract

Introduction Esophagogastroduodenoscopy is currently considered the first-line diagnostic procedure of choice for upper gastrointestinal (GI) bleeding; however, the etiology of bleeding remains unknown in a subset of patients. This study aims to evaluate the diagnostic yield of upper gastrointestinal endoscopy in upper gastrointestinal bleeding in pediatrics and determine the clinical predictors for unreached diagnosis during endoscopy. Methods Cross sectional study, conducted at pediatric endoscopy unit, Ain Shams University, Cairo, Egypt, where 100 patients were recruited, as they were referred for diagnostic upper GI endoscopy due to overt upper GI bleeding in the form of hematemesis and/or melena. Full medical history, examination, laboratory investigations, endoscopic and histopathologic findings were documented. Results :100 patients with ages ranging from 3 months to 15 years, median age 4 years, 47% males and 53% females, 65% presented by hematemesis only, 7% with melena only, and 28 % presented with both hematemesis and melena. In 38 % of cases no endoscopic diagnosis was reached. While patients with a positive diagnostic yield 62%, had variable diagnosis, the most common of which was H pylori gastritis and reflux oesophagitis in 23% and 11% of cases respectively. Followed by nonspecific gastritis (8%), oesophageal varices (4%), and others (16%).. Melena was a negative predictor to reach a diagnosis by upper GI endoscopy. Conclusion Diagnostic yield of upper GI endoscopy in pediatric patients with upper GI bleeding was only 62%. Combining upper GI endoscopy with other tools in cases presenting with melena alone is highly recommended since bleeding from a source in the small bowel or right colon may also be the cause.