Pediatric Gastroenterology, Hepatology & Nutrition

  • 제27권2호
  • /
  • Pages.113-124
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  • 2024
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  • 2234-8646(pISSN)
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  • 2234-8840(eISSN)
대한소아소화기영양학회 (The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition)
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Which Alarm Symptoms Are Associated With Abnormal Gastrointestinal Endoscopy Among Thai Children?

  • Anundorn Wongteerasut (Department of Pediatrics, Phramongkutklao Hospital and Phramongkutklao College of Medicine)
  • 투고 : 2023.04.16
  • 심사 : 2023.10.27
  • 발행 : 2024.03.15
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초록

Purpose: Alarm symptoms (red flag signs) are crucial indications for management decisions on pediatric gastrointestinal endoscopy. We aimed to identify items in the alarm symptoms and pre-endoscopic investigations that predict abnormal endoscopy results. Methods: A retrospective descriptive study was conducted among children aged under 18 years undergoing endoscopy. The patients were classified into normal and abnormal endoscopic groups. The incidence of alarm symptoms and pre-endoscopic investigations were compared between the groups. Univariate and multivariate logistic regression analyses were performed to determine independent risk factors for abnormal endoscopy. Results: Of 148 participants, 66 were classified in the abnormal endoscopy group. Compared with the normal group, the abnormal group had a significantly higher prevalence of alarm symptoms. Moreover, hematemesis/hematochezia, anemia, low hemoglobin level, hypoalbuminemia, rising erythrocyte sedimentation rate, increased serum lipase, and blood urea nitrogen/creatinine ratio were significantly higher in the abnormal endoscopy group than in the normal group. Multivariate logistic regression analysis indicated that hematemesis/hematochezia and low hemoglobin level were independent risk factors for abnormal endoscopy. Conclusion: The alarm symptoms and pre-endoscopic investigations were evaluated using predictive factors for abnormal pediatric endoscopic findings. According to multivariate logistic regression analysis, hematemesis/hematochezia and low hemoglobin levels were independent risk factors for abnormal endoscopy.

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참고문헌

  1. Freeman NV. Clinical evaluation of the fiberoptic bronchoscope (Olympus BF 5B) for pediatric endoscopy. J Pediatr Surg 1973;8:213-20. https://doi.org/10.1016/S0022-3468(73)80087-9
  2. Gilger MA. Gastroenterologic endoscopy in children: past, present, and future. Curr Opin Pediatr 2001;13:429-34. https://doi.org/10.1097/00008480-200110000-00008
  3. Chung HK, Lightdale JR. Sedation and monitoring in the pediatric patient during gastrointestinal endoscopy. Gastrointest Endosc Clin N Am 2016;26:507-25. https://doi.org/10.1016/j.giec.2016.02.004
  4. Fachler T, Shteyer E, Meyer EO, Shemasna I, Tzion RL, Rachman Y, et al. Pediatric gastrointestinal endoscopy: diagnostic yield and appropriateness of referral based on clinical presentation: a pilot study. Front Pediatr 2021;9:607418.
  5. Lee WS, Zainuddin H, Boey CCM, Chai PF. Appropriateness, endoscopic findings and contributive yield of pediatric gastrointestinal endoscopy. World J Gastroenterol 2013;19:9077-83. https://doi.org/10.3748/wjg.v19.i47.9077
  6. Silva S, Silva C, do Ceu Espinheira M, Pais IP, Trindade E, Dias JA. Diagnostic yield of endoscopic procedures in children: experience of a portuguese center. GE Port J Gastroenterol 2020;27:404-9.  https://doi.org/10.1159/000507207
  7. Elitsur Y. The diagnostic yield of upper endoscopy procedures in children- is it cost effective? Curr Gastroenterol Rep 2014;16:385.
  8. Akbulut UE, Emeksiz HC, Kocak FG, Livaoglu A. Diagnostic yield of esophagogastroduodenoscopy in children with chronic abdominal pain. Arch Med Sci 2018;14:74-80. https://doi.org/10.5114/aoms.2017.67675
  9. Altamimi E, Odeh Y, Al-Quraan T, Mohamed E, Rawabdeh N. Diagnostic yield and appropriate indication of upper endoscopy in Jordanian children. BMC Pediatr 2021;21:10.
  10. Wu CT, Chen CA, Yang YJ. Characteristics and diagnostic yield of pediatric colonoscopy in Taiwan. Pediatr Neonatol 2015;56:334-8. https://doi.org/10.1016/j.pedneo.2015.01.005
  11. Di Lorenzo C, Colletti RB, Lehmann HP, Boyle JT, Gerson WT, Hyams JS, et al. Chronic abdominal pain in children: a technical report of the American Academy of Pediatrics and the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr 2005;40:249-61. https://doi.org/10.1097/01.MPG.0000154661.39488.AC
  12. Reust CE, Williams A. Recurrent abdominal pain in children. Am Fam Physician 2018;97:785-93.
  13. Tringali A, Thomson M, Dumonceau JM, Tavares M, Tabbers MM, Furlano R, et al. Pediatric gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) and European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) Guideline Executive summary. Endoscopy 2017;49:83-91. https://doi.org/10.1055/s-0042-111002
  14. Gijsbers CFM, Benninga MA, Schweizer JJ, Kneepkens CMF, Vergouwe Y, Buller HA. Validation of the Rome III criteria and alarm symptoms for recurrent abdominal pain in children. J Pediatr Gastroenterol Nutr 2014;58:779-85. https://doi.org/10.1097/MPG.0000000000000319
  15. Alper A, Zhang L, Pashankar DS. Correlation of erythrocyte sedimentation rate and C-reactive protein with pediatric inflammatory bowel disease activity. J Pediatr Gastroenterol Nutr 2017;65:e25-7. https://doi.org/10.1097/MPG.0000000000001444
  16. Mack DR, Langton C, Markowitz J, LeLeiko N, Griffiths A, Bousvaros A, et al. Laboratory values for children with newly diagnosed inflammatory bowel disease. Pediatrics 2007;119:1113-9. https://doi.org/10.1542/peds.2006-1865
  17. Takaki Y, Mizuochi T, Eda K, Ishihara J, Yamashita Y. Laboratory values in Japanese children with newly diagnosed inflammatory bowel disease. Pediatr Int 2019;61:720-5. https://doi.org/10.1111/ped.13892
  18. Reedy RA, Filipp SL, Gurka MJ, Shenoy A, Davis MK. Utility of esophagogastroduodenoscopy in the evaluation of uncomplicated abdominal pain in children. Glob Pediatr Health 2019;6:2333794X19898345. 
  19. Tolone C, Pellino V, Piccirillo M, Letizia M, Belfiore I, Tolone S. Recurrent abdominal pain in children: underlying pathologies in the absence of "alarm" symptoms. Minerva Pediatr 2017;69:239-44. https://doi.org/10.23736/S0026-4946.16.04247-X
  20. Wang S, Qiu X, Chen J, Mei H, Yan H, You J, et al. Pediatric esophagogastroduodenoscopy in china: indications, diagnostic yield, and factors associated with findings. BMC Pediatr 2022;22:522.
  21. Helin N, Kolho KL, Rintala R, Merras-Salmio L. Upper endoscopy for non-acute non-specific symptoms is seldom beneficial for children under the age of seven. Acta Paediatr 2020;109:827-35. https://doi.org/10.1111/apa.15027
  22. Mark JA, Campbell K, Gao D, Kramer RE. Algorithm to predict which children with chronic abdominal pain are low suspicion for significant endoscopic findings. Clin Pediatr (Phila) 2019;58:79-87. https://doi.org/10.1177/0009922818806317
  23. Khan K, Schwarzenberg SJ, Sharp H, Greenwood D, Weisdorf-Schindele S. Role of serology and routine laboratory tests in childhood inflammatory bowel disease. Inflamm Bowel Dis 2002;8:325-9. https://doi.org/10.1097/00054725-200209000-00003
  24. Bachmeier CAE, Morton A. Man with epigastric pain and persistently elevated serum lipase. BMJ Case Rep 2019;12:e229208.
  25. Muniraj T, Dang S, Pitchumoni CS. PANCREATITIS OR NOT?--Elevated lipase and amylase in ICU patients. J Crit Care 2015;30:1370-5. https://doi.org/10.1016/j.jcrc.2015.08.020
  26. Wani MA, Zargar SA, Yatoo GN, Haq I, Shah A, Sodhi JS, et al. Endoscopic yield, appropriateness, and complications of pediatric upper gastrointestinal endoscopy in an adult suite: a retrospective study of 822 children. Clin Endosc 2020;53:436-42. https://doi.org/10.5946/ce.2019.118
  27. Berger TD, Soffer S, Vurzel-Harel T, Silbermintz A, Fleishaker H, Shamir R, et al. The yield of upper gastrointestinal endoscopy at a pediatric tertiary care center. Isr Med Assoc J 2020;22:164-8.
  28. Thomson M, Sharma S. Diagnostic yield of upper and lower gastrointestinal endoscopies in children in a tertiary centre. J Pediatr Gastroenterol Nutr 2017;64:903-6. https://doi.org/10.1097/MPG.0000000000001582
  29. Kawada PS, O'Loughlin EV, Stormon MO, Dutt S, Lee CH, Gaskin KJ. Are we overdoing pediatric lower gastrointestinal endoscopy? J Pediatr Gastroenterol Nutr 2017;64:898-902. https://doi.org/10.1097/MPG.0000000000001192
  30. Hochman JA, Figueroa J, Duner E, Lewis JD. Diagnostic yield variation with colonoscopy among pediatric endoscopists. Dig Dis 2020;38:421-30. https://doi.org/10.1159/000504837
  31. El-Mouzan MI, Abdullah AM. Yield of colonoscopy in children with rectal bleeding. Saudi Med J 2004;25:998-1001.
  32. Sheiko MA, Feinstein JA, Capocelli KE, Kramer RE. Diagnostic yield of EGD in children: a retrospective single-center study of 1000 cases. Gastrointest Endosc 2013;78:47-54.e1. https://doi.org/10.1016/j.gie.2013.03.168
  33. El Mouzan MI, Abdullah AM, Al-Mofleh IA. Yield of endoscopy in children with hematemesis. Trop Gastroenterol 2004;25:44-6.
  34. Thakkar K, Gilger MA, Shulman RJ, El Serag HB. EGD in children with abdominal pain: a systematic review. Am J Gastroenterol 2007;102:654-61. https://doi.org/10.1111/j.1572-0241.2007.01051.x
  35. Bonilla S, Deli W, Saps M. The prognostic value of obtaining a negative endoscopy in children with functional gastrointestinal disorders. Clin Pediatr (Phila) 2011;50:396-401. https://doi.org/10.1177/0009922810392773