P1033 ENDOSCOPY IN PEDIATRIC PATIENTS WITH CANCER

Abstract

Introduction: Current chemotherapeutic treatment regimes in children with cancer often cause gastrointestinal side-effects. However, only limited data exist on the use of endoscopy for the diagnosis of gastrointestinal abnormalities in this group of patients as well as for therapeutic endoscopies. Therefore, we retrospectively reviewed our experience with diagnostic and therapeutic endoscopy in children with cancer. Methods: Retrospective chart- and endoscopy-database-review from 1/93 through 6/01 identified 57 endoscopies (49 upper endoscopies, 4 colonoscopies, 3 sigmoidoscopies, 1 rectos-copy), performed in 38 patients (21 male, 17 female, mean age 12,8 years). 17 children (45%) had haematological malignancies and 21 (55%) had solid tumors. 14 patients (36,8%) had more than one endoscopy. At the time of 45 endoscopies patients received chemotherapy and/or radio therapy, with 6 undergoing high dose chemotherapy followed by autologous peripheral stem cell transplantation. In 12 children platelets were <50x109/l, 10 were neutropenic (ANC<1x109/l). Results: 40 diagnostic endoscopies were performed, 7 were done for follow-up, 10 endoscopies had therapeutic indications. Biopsies for histopathological evaluation were taken in 30 (75%) of 40 diagnostic endoscopies, samples for microbiologic studies in 17 (42,5%). Pathologic findings, based on endoscopy, histology or microbiology, were identified in 33 (82,5%) of the 40 diagnostic endoscopies. Main findings were: Oesophagitis 15 (37,5%; 2 of them infections:1 candida, 1 HSV), Mallory-Weiss tear 5 (12,5%), gastritis 18 (45%; 4 H.pyl. pos.), ulcer 1 (2,5%), duodenitis 11 (27,5%), neoplasia 3 (7,5%), colitis 5 (12,5%). Specific therapy was initiated or changed in 23 patients, in 3 patients the diagnosis of neoplasia was established by endoscopy. Therapeutic endoscopies: PEG-tube placement in 4 children, 1 tube removal after rehabilitation. Sclerotherapy for esophageal varices was performed twice. Nasojejunal tubes for enteral nutrition in 3 children. Further 3 tubes were placed in primary diagnostic endoscopies. Complications: 1 episode of fever (>38.5°C) and abdominal distension after colonoscopy, 1 localised infection after PEG-placement, both resolved with iv-antibiotics, no further major complications. Neutropenia was not associated with more infections. There was no bleeding in thrombocytopenic patients. Conclusion: Our data show that endoscopy in pediatric patients with malignant diseases is a safe procedure, even in high risk patients. With a high probability endoscopy will reveal relevant information (even malignancy) and thus have therapeutic impact. Tube placement techniques can help to maintain enteral nutrition.