Appropriateness of Upper Gastrointestinal Endoscopy in Children: A Retrospective Study

Jantchou, Prévost; Schirrer, Jacques; Bocquet, Alain

Journal of Pediatric Gastroenterology & Nutrition:
doi: 10.1097/MPG.0b013e31802c6847
Original Articles: Gastroenterology
Abstract

Background: Upper gastrointestinal endoscopy (UGIE) is appropriate in many situations in adults and children. Recommendations for UGIE use in children were published recently by the French-language Paediatric Hepatology, Gastroenterology, and Nutrition Group (GFHGNP).

Patients and Methods: We retrospectively reviewed the 293 UGIE procedures undertaken in 251 children between January 1, 2001 and June 30, 2003 by 2 senior endoscopists. The UGIE procedures were categorized as appropriate or inappropriate based on GFHGNP recommendations, and diagnostic efficiency was compared in the 2 groups with the χ2 test followed by multivariate logistic regression analysis.

Results: Of the 293 UGIE procedures, 52 (17.7%) were considered inappropriate. Diagnostic efficiency was 51% in the appropriate group versus 17.3% in the inappropriate group (odds ratio, 4.2; 95% CI, 2–8.7; P < 10−3). The proportion of appropriate UGIE procedures was higher among inpatients than outpatients (odds ratio, 2.51; 95% CI, 1.24–5.08; P = 0.01). Inappropriate reasons for performing UGIE included isolated failure to thrive and follow-up after neonatal esophagogastroduodenitis. Nine inappropriate UGIE procedures contributed useful information: ulcerative esophagitis in 1 patient, hemorrhagic esophagitis in 4 patients, duodenitis in 1 patient, and malabsorption in 3 patients caused in 1 case by cow's milk allergy and in 2 cases to fully documented celiac disease.

Conclusions: UGIE was usually performed appropriately in our pediatric hospital. Inappropriate UGIE procedures were more common in outpatients than in admitted patients. Awareness of the recommendations for appropriate UGIE use needs to be improved among office-based and hospital-based physicians.

Author Information

Pediatrics Department, Besançon Teaching Hospital, Besançon, France

Received 27 September, 2005

Accepted 20 October, 2006

Address correspondence and reprint requests to Prévost Jantchou, MD, Service de Pédiatrie CHU Besançon, 2, Place Saint Jacques, 25000 Besançon, France (e-mail: jantchou_prevost@yahoo.fr).

© 2007 Lippincott Williams & Wilkins, Inc.