P0752 OUTCOMES OF UPPER AND LOWER GASTROINTESTINAL ENDOSCOPIES IN CHILDREN AND ADOLESCENTS: THE EXPERIENCE OF ONE TERTIARY CARE PEDIATRIC GASTROENTEROLOGY SERVICE

Abstract

Introduction: Endoscopies have been performed in children since the 1970s and are considered the gold standard procedure for many diseases of the upper and lower gastrointestinal tract (1). Here, we describe the clinical indications for endoscopy, the type of sedation used, the complications, and the endoscopic and histologic outcomes of upper and lower endoscopies in a population of children and adolescents. Methods: Retrospective review of all endoscopies performed from Jan. 1 to Dec. 31 2000 at the St. Justine Hospital in Montreal, Quebec. Results: 577 upper and 299 lower endoscopies were performed during this period. The age range was 1 month to 22 years with median and mode ages of 9 and 1 years for upper and 11 and 15 years for lower endoscopies. Most procedures were done under conscious sedation; general anesthesia was used in 26% and 11% of upper and lower endoscopies respectively. Upper endoscopies were performed mainly for abdominal pain, nausea or regurgitation, and vomiting and lower endoscopies for abdominal pain, diarrhea, and rectal bleeding. Therapeutic interventions were done in 13% of upper and 6% of lower endoscopies. Minor adverse events (mild cutaneous &/or respiratory reactions to medications used for sedation, patient discomfort) occurred in 5% of upper and 8% of lower endoscopies. Moderate to severe adverse events (cardiorespiratory problems, perforation, bleeding), occurred in 1.9% of upper and 1.3% of lower endoscopies. 95% of upper and 77% of lower endoscopies were completed. Abnormal endoscopic findings were found in 50% and 47% of upper and lower endoscopies respectively while abnormal histologic findings were found in 50% and 64%. Overall, evidence of pathology on endoscopic and/or histologic exam was found in 67% of upper and 70% of lower endoscopies. Abnormal findings on endoscopic exam predicted abnormal histologic findings in 51% and 80% of upper and lower endoscopies respectively (positive predictive values). Similarly, normal findings on endoscopic exam predicited normal histologic findings in 63% and 60% of upper and lower endoscopies respectively (negative predictive values). Conclusion: Upper and lower endoscopies were well tolerated in this population and abnormal endoscopic and histologic findings were common. Endoscopy findings were only predictive of histology findings for abnormal lower endoscopy exams. Prospective studies are required to assess the impact of these procedures on clinical outcomes.