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Abstract
Background/Aims
In pediatrics, endoscopic examination has become a common procedure for evaluation of gastrointestinal presentations. However, there are limited data on pediatric endoscopy in Korea. The aim of this study was to analyze the current status and clinical impacts of endoscopic examination in children and adolescents.
Methods
We retrospectively reviewed the medical records of outpatients who visited the tertiary hospital. Patients under 18 years of age who underwent endoscopy were included. Endoscopic findings were classified as specific and normal based on gross findings. Specific endoscopic findings were reflux esophagitis, peptic ulcers, and Mallory-Weiss tear. Other findings included acute gastritis classified according to the updated Sydney system.
Results
In 722 of 330,350 patients (0.2%), endoscopic examination (554 esophagogastroduodenoscopies [EGDs], 121 colonoscopies, 47 sigmoidoscopies) was performed between January 2008 and January 2013. In EGD, abdominal pain was the most frequent presentation (64.1%). The most common diagnosis was gastritis (53.2%), followed by reflux esophagitis. The frequency of peptic ulcer disease was 12.8%. Frequent symptoms leading to colonoscopic examination were abdominal pain, diarrhea, and hematochezia. In colonoscopy, a negative result was more likely in children younger than 7 years old. After the procedure, the diagnostic yield of EGD and colonoscopy was 88.1% and 45.8%, respectively, and the rate of change in management was 67.1%.
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Fig. 1.
Gastritis was the most common diagnosis of pediatric esophagogastroduodenoscopy; erythematous and edematous mucosal change in the whole stomach.
Fig. 2.
Various findings during pediatric colonoscopy; (A) Crohn's disease, (B) intestinal tuberculosis, (C) lymphoma, (D) rectal ulcer.
Table 1.
Leading Symptoms in Esophagogastroduodenoscopy
Table 2.
Comparison of Endoscopic Findings in Two Groups according to Age above 7 Years or below 7 Years
| Endoscopic finding (%) |
Group (yr) |
p-value | |
|---|---|---|---|
| ≤7 (n=85) | >7 (n=469) | ||
| Gastritis (46.6) | 17 (20.0) | 241 (51.4) | <0.01 a |
| Peptic ulcer (12.8) | |||
| GU | 5 (5.9) | 22 (4.7) | 0.68 |
| DU | 2 (2.4) | 40 (8.5) | 0.12 |
| GU combined DU | 1 (1.1) | 1 (0.2) | 0.17 |
| Reflux esophagitis (15.3) | 2 (2.4) | 83 (17.7) | <0.01 a |
| Foreign body (9.9) | 46 (54.1) | 9 (2.0) | <0.01 a |
| Duodenitis (0.9) | 1 (1.1) | 4 (0.9) | 0.76 |
| Henoch-Schonlein purpura (0.7) | 3 (3.5) | 1 (0.2) | <0.01 a |
| Other (1.8) | 2 (2.4) | 8 (1.6) | 0.68 |
| Normal (11.9) | 6 (7.1) | 60 (12.8) | 0.13 |
Table 3.
Leading Symptoms in Colonoscopy and Sigmoidoscopy
Table 4.
Comparison of Endoscopic Findings in Two Groups according to Age above 7 Years or below 7 Years
| Endoscopic finding (%) |
Group (yr) |
p-value | |
|---|---|---|---|
| ≤7 (n=21) | >7 (n=147) | ||
| Nomal (54.2) | 16 (76.2) | 75 (51.0) | 0.03 a |
| Colitis/ileitis/proctitis (14.3) | 2 (9.5) | 22 (15.0) | 0.74 |
| Inflammatory bowel disease (19.6) | 0 | 33 (22.4) | 0.01 a |
| Crohn's disease | 0 | 21 (14.3) | |
| Ulcerative colitis | 0 | 12 (8.2) | |
| Intestinal tuberculosis (4.2) | 2 (9.5) | 5 (3.4) | 0.21 |
| Hemorrhoid (4.2) | 0 | 7 (4.8) | 0.59 |
| Polyp (1.8) | 1 (4.8) | 2 (1.3) | 0.33 |
| Rectal ulcer (1.2) | 0 | 2 (1.3) | 1.0 |
| Lymphoma (0.6) | 0 | 1 (0.7) | 1.0 |
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