Endoscopic Procedures In Children Research Articles

ASSESSMENT OF YIELD ON SAME DAY DUAL ENDOSCOPIC PROCEDURES, THEIR COST COMPARISON AND PARENTAL ACCEPTANCE IN A SINGLE INSTITUTION

78 Little information is available on the yield of same day dual endoscopic procedures in children/adults. Methods: A chart review of 51 patients who underwent same day dual endoscopic procedures-Esophagogastroduodenoscopy and Flexible Sigmoidoscopy (EFS) or Esophagogastroduodenoscopy and Colonoscopy (EC) was done. The indications were: Chronic diarrhea (33%), Inflammatory Bowel Disease (37%), Abdominal pain (10%), Gastrointestinal bleed (16%), Failure to thrive (2%) and Graft versus Host disease (2%). Endoscopic and histologic findings were noted in each case. A cost comparison was made on both procedures being performed on the same day versus if performed on separate days. A questionnaire assessing parental satisfaction, preferences, degree of anxiety, inconvenience etc. regarding procedures being performed on the same day versus on different days was completed in 23/51 patients. Results: 41/51 (80.3%) had positive endoscopic findings. 7/10 patients with normal endoscopic exams had abnormal histologic findings. Only 3/51 (5.9%) had both negative endoscopic and histologic findings. Cost comparisons excluding professional fees were made if patients Operating room and in the Endoscopy suite. An average savings of $1292.00 for EFS/EC was noted for same day procedures in the Operating room and $615.00 for procedures done in the Endoscopy suite as compared to separate day procedures. Completed questionnaires suggested that 95% of parents preferred same day procedures. 82% of parents felt that child would be more stressed if the procedures were done on separate days. 87% of parents would have needed additional time off work and 59% would need to make special arrangements for child care. Conclusions: In carefully selected patients same day dual endoscopic procedures in children have a high positive yield, lead to significant cost savings and have a high overall acceptance by parents. Additional studies are needed to assess individual institutional trends.

Absence of bacteremia after gastrointestinal procedures in children

Background:Transient bacteremia after certain gastrointestinal endoscopies is well documented in adult patients; however, experience in pediatric patients is very limited. We conducted a prospective study to determine the frequency of bacteremia after common endoscopic procedures in children. Methods:A total of 108 endoscopies were performed in 95 patients (age range 8 months to 17 years; mean age 10.2 years). Procedures included 68 esophagogastroduodenoscopies (EGDs), 29 colonoscopies, and 11 flexible sigmoidoscopies. Most procedures (88) were performed with patients under conscious sedation; 20 were under general anesthesia with endotracheal intubation. Biopsy specimens were obtained from all patients. Blood samples for aerobic and anaerobic cultures were obtained prior to, and within 5 minutes of, completion of the procedure. In patients who underwent general anesthesia, a third sample was obtained 5 minutes after endotracheal intubation and before endoscopy. Results:Four of the pre-endoscopic blood cultures were positive. Two cultures were positive after endotracheal intubation, but were negative after endoscopy. Four cultures were positive after endoscopy. All organisms were skin or environmental flora and were considered contaminants. All patients with positive cultures remained asymptomatic during the 72 hours after the procedure. Conclusion:We conclude that clinically relevant bacteremia is very infrequent following routine endoscopic procedures with biopsies in immunocompetent children. (Gastrointest Endosc 1996;44:378-81.)