Su1740 The Diagnostic Yield of Upper Endoscopy in Children: Do Symptoms Matter?

Abstract

prospective data collection using a standard computerized report generator and central registry (PEDS-CORI) to examine factors affecting examination of the ileum during colonoscopies performed in 14 pediatric centers between Jan 2000 and Dec 2011. Procedures with and without examination of the ileum were compared with regards to demographic and clinical features in practices with more than 100 colonoscopy procedures during the study period. Results: We analyzed 21, 807 colonoscopy procedures performed in patients with mean age of 11.9 (SD 4.8). Overall, 15,130 (69%) of colonoscopies included examination of the ileum. Patients in which the ileum was not examined were younger, had higher ASA class, and were more likely to have procedures performed under intravenous sedation. Procedures done under general anesthesia were associated with intubation rate of 76%, while other sedation types (intravenous sedation) had a significantly lower intubation rate of 63% ( p!0.001). Procedures done in male patients achieved an intubation rate of 68%, significantly lower than the 71% rate seen in female patients ( p!0.001). The presence of a fellow was not associated with ileal intubation (pZ0.072). Colonoscopies done with an adequate bowel prep reported a higher rate of intubation than those without (94% vs. 82%; p!0.001). Of the 21, 807 reports received during the study period, 56% did not document bowel prep quality, 31% did not include duration of procedure, and 12.7% did not include ASA classification. Conclusions: Approximately, 30% of colonoscopy procedures in children did not include complete examination (i.e., reach the ileum). Several factors including age, sedation method, ASA class, and quality of bowel prep are associated with examination of the terminal ileum during colonoscopy in children. Su1740 The Diagnostic Yield of Upper Endoscopy in Children: Do Symptoms Matter? Barra Alabd Alrazzak, Deborah Preston, Yoram Elitsur* Pediatrics, Gastroenterology, Marshall University, Huntington, WV; Pediatrics, Gastroenterology, Marshall University, Huntington, WV Introduction: Upper endoscopic (EGD) procedure in children is a common diagnostic tool for children with various abdominal symptoms. The diagnostic value of EGD in regards to positive histology and its association with symptoms has not been adequately investigated. Previous reports suggested that in up to 62% of diagnostic EGD, no histologic abnormalities are found. (Hyams JS. JPGN 2000). Aim: to evaluate the correlation between symptoms and histology in children who undergo the first diagnostic upper endoscopy procedure at our gastroenterology clinic. Method: A retrospective chart review of all children who had their first diagnostic upper endoscopy procedure, between 2006 and 2011, was performed. Demographic, clinical symptoms and histology were collected. Mucosal biopsies from the esophagus, stomach and small intestine were available in all patients irrespective of the tissue appearance. Children with the diagnosis of chronic recurrent abdominal pain were excluded from the study. Results: A total of 728 endoscopy charts were reviewed. Male/Female ratio and mean age were 1.12:1.0, and 11.5 years, respectively. The most common presenting symptom in our cohort was abdominal pain (64%) followed by N&V (23%), FTT (6.4%), GI bleed (6%), and dysphagia (5.6%). The most common pathologic finding was gastritis (56%) followed by esophagitis (37%), duodenitis (11%), EoE (10%), and H. pylori-associated gastritis (2%) (Table 1). In 260 (36%) procedures, no pathology was found in either of the organs (esophagus, stomach, duodenum). The sensitivity and specificity to detect mucosal pathology for any symptom ranged between 5668% and 3440%, respectively, with no significant differences among the symptoms (Table 2). Conclusion: In over a third of our EGD’s no mucosal pathology was found. The accuracy rate to detect pathology was approximately 80% for abdominal pain but was below 50% for all other presenting symptoms. With increasing cost of endoscopic procedures, calculation of cost analysis is needed in order to assess the diagnostic yield of this procedure in children with various GI symptoms. Table 1. Presenting symptoms and histology