Practices in Paediatric Gastrointestinal Endoscopy at Kenyatta National Hospital and Gertrude’s Children’s Hospital in Nairobi, Kenya

Abstract

Background: Gastrointestinal (GI) diseases are common in children worldwide and pediatric GI endoscopy has become a fundamental component of healthcare for infants and children. There is a wide range of diagnostic and therapeutic indications for pediatric upper and lower GI endoscopy as well as new diagnostic and therapeutic interventions for the endoscopic findings Objectives: To document the indications, endoscopic findings and therapeutic procedures in pediatric upper and lower gastrointestinal endoscopy at the Kenyatta National Hospital (KNH) and Gertrude’s children’s hospital. Design: Cross-sectional, consecutive entry study Setting: Kenyatta National Hospital and Gertrude’s children’s hospital Materials and Methods: This study was done over a period of 5 months involving participants of age 13 years and below who underwent GI endoscopy at the endoscopy units of KNH and Gertrude’s children’s hospital. The subjects who met the eligibility criteria were recruited by the Principal Investigator through consecutive sampling. Data was recorded in a data abstraction form. Permission to undertake the study was obtained from the combined institutional Research and Ethics Committee (IREC) of KNH and University of Nairobi as well as the Ethics Review Board of Gertrude’s Children Hospital.Data was anonymized prior to analysis. Written informed consent for the study was obtained from the participants’ parents or guardians. The data collected was coded and entered in MsAccess data base. Data cleaning was done and the data exported into SPSS version 23.0statistical software. All statistical tests were performed at 5% level of significance. Results: Mean age of the children was 7.3 years (std=3.9). Males were 58 (52.7%). OGD involved 79.1% of the participants. In KNH, the main indications for OGD (oesophagogastroduodenoscopy) were upper GI bleed and dysphagia while in Gertrude’s hospital, they were abdominal pain and emesis. Hematochezia was the predominant indication for colonoscopy. More study participants had normal than abnormal gross and histological findings. The commonest gastroscopic findings were gastritis and esophagitis. Hiatus hernia was detected in only 4.8% of the children. The commonest colonoscopic finding was colonic polyps. 69(62.7%) patients had results of biopsies taken being present. The commonest positive findings in the colon and rectum were chronic ulcerative colitis and juvenile polyps, respectively. The main therapeutic procedures done were banding for oesophageal varices, FB removal and oesophageal dilatation. Conclusions: The higher percentages of normal gross and histologic findings indicate more a functional than organic etiology to the GI presentations. Hiatus hernia is relatively uncommon in our population. Juvenile polyps are more common than ulcerative colitis as a cause of hematochezia in children. Recommendations: Considerations for higher possibility of functional diagnoses should be made for patients with recurrent abdominal pains and recurrent emesis. Emphasis should be made for parents/guardians of children who require biopsy that histology forms a crucial part of management