Appropriateness, endoscopic findings and contributive yield of pediatric gastrointestinal endoscopy

Table 1 Characteristics of 310 children undergoing 345 endoscopic procedures n (%)

Age
< 6 mo	3 (1)
6 mo-2 yr	32 (11)
2-10 yr	185 (61)
> 10 yr	81 (27)
Gender
Male	158 (53)
Female	143 (47)
Weight-for-age
< 3rd centile	123 (41)
3rd-50th centile	154 (51)
50th-95th centile	22 (6)
> 95th centile	4 (1.4)
Type of procedure
Esophagogastroduodenoscopy	231 (77)
Colonoscopy	26 (9)
Both	44 (15)

Three hundreds and forty-five endoscopic procedures took place in University Malaya Medical Center, Kuala Lumpur; January 2008 to June 2011.

Table 2 Indications for esophagogastroduodenoscopy and colonoscopy in 310 children n (%)

Indications	Value
Esophagogastroduodenoscopy
Diagnostic
Variceal surveillance/eradication	137 (48.9)
Hematemesis	41 (14.9)
Significant recurrent abdominal pain	37 (13.4)
Malenic stool	20 (7.3)
Chronic diarrhea/malabsorption	16 (5.8)
Recurrent vomiting	5 (1.8)
Malignancy surveillance	5 (1.8)
Dysphagia/odynophagia	4 (1.4)
Complicated gastroesophageal reflux disease	3 (1.0)
Unexplained anemia	1 (0.3)
Failure to thrive	1 (0.3)
Therapeutic
Gastrostomy insertion	2 (0.7)
Foreign body removal	1 (0.3)
Colonoscopy
Rectal bleeding	19 (27.0)
Monitoring of inflammatory bowel disease	19 (27.0)
Chronic diarrhea/malabsorption	18 (25.7)
Surveillance for polyp syndrome	6 (8.5)
Recurrent abdominal pain	5 (7.1)
Malignancy surveillance	3 (4.2)

Table 3 Therapeutic procedures n (%)

Procedures	Value
Esophageal varices eradication
Rubber banding for esophageal varices	64 (74)
Sclerotherapy	18 (21)
Polypectomy	2 (2.3)
Foreign body removal	1 (1)
Insertion of percutaneous gastrostomy feeding tube	2 (2)
Total	86 (100)

Table 4 Probability of positive (abnormal) vs negative (normal) endoscopic findings n (%)

Procedures	Endoscopic findings		Total
	Positive	Negative
Esophagogastroduodenoscopy	216 (79)	59 (21)	275 (100)
Colonoscopy	45 (64)	25 (36)	70 (100)
All	261 (76)	84 (24)

Table 5 Univariate analysis for clinical parameters predicting a positive (abnormal) endoscopic finding

Clinical parameters	Positive contributive yield (a change in diagnosis)			Positive contributive yield (a change in treatment)
	P value	OR	95%CI	P value	OR	95%CI
Symptoms
Vomiting	< 0.001	4.5	2.0-10.3	0.456	1.4	0.5-3.5
Diarrhea	0.010	2.6	1.5-4.2	0.940	0.4	0.4-1.8
Abdominal pain	0.020	2.1	1.1-4.0	0.750	0.9	0.5-1.7
Hematemesis	0.321	1.7	0.5-5.5	0.001	4.3	1.7-10.3
Melena	0.048	0.7	0.05-0.5	0.027	0.6	0.27-1.4
Hematochezia	0.065	2.0	0.9-4.3	0.040	2.8	1.3-5.7
Signs
Pallor	0.525	1.2	0.5-2.8	0.520	1.2	0.6-2.3
Hepatomegaly	0.551	1.4	0.43-4.7	0.825	0.9	0.5-1.7
Splenomegaly	< 0.001	0.082	0.029-0.2	0.227	0.6	0.3-1.2
Abdominal tenderness	0.396	0.5	0.14-2.1	0.242	0.37	0.07-1.9

Table 6 Multivariate analysis for clinical parameters predicting a positive (abnormal) endoscopic finding

Clinical parameters	Positive contributive yield (a change in diagnosis)			Positive contributive yield (a change in treatment)
	P value	OR	95%CI	P value	OR	95%CI
Symptoms
Vomiting	< 0.001	4.5	2.0-10.3	0.827	0.9	0.4-2.6
Diarrhea	0.014	2.6	1.5-4.7	0.448	0.8	0.4-1.4
Abdominal pain	< 0.001	3.7	2.1-6.4	0.664	0.6	0.4-1.6
Hematemesis	0.251	1.5	0.7-3.3	< 0.001	4.3	1.8-9.5
Melena	0.080	1.7	0.9-4.3	0.022	2.9	1.0-5.2
Hematochezia	0.010	3.1	1.6-6.3	0.020	1.9	1.1-4.5
Signs
Pallor	0.768	1.4	0.5-2.1	0.113	2.0	0.8-3.0
Hepatomegaly	0.004	0.2	0.1-0.5	0.629	1.3	0.6-1.9
Splenomegaly	< 0.001	0.08	0.04-0.17	0.198	1.3	0.8-2.0
Abdominal tenderness	0.267	1.9	0.5-2.1	0.097	0.2	0.05-3.0

Table 7 Endoscopic findings and a subsequent contributive yield n (%)

Endoscopic findings	Positive contributive yield (a change in diagnosis)		Positive contributive yield (a change in management)		Total
	Yes	No	Yes	No
Positive	64 (18.6)1	197 (57.1)	145 (42.0)2	116 (33.6)	261 (75.7)
Negative	15 (4.3)	69 (20.0)	8 (2.3)	76 (22.0)	84 (24.3)
Total	79 (22.9)	266 (77.1)	153 (44.3)	192 (55.7)	345 (100)

¹P = 0.234 (χ² test);

²P < 0.001 (χ² test).

Table 8 Adverse events encountered in 345 endoscopic procedures

Complications	n
Procedure-related
Secondary bleeding following rubber banding or sclerotherapy	12
Bowel perforation during colonoscopy	2
Anesthesia/sedation-related
Delayed extubation due to ascites	2
Post-extubation bronchospasm	1
Secondary fever	3
Total	20