Outcomes of Diagnostic Endoscopy

Abstract

Paediatric endoscopy is an important tool in diagnosing and ruling out gastrointestinal pathology. However, little published data exists to guide selection of patients for endoscopy. Existing guidance contains weak recommendations based on low quality evidence.1 We have previously published data showing the diagnostic yield of macroscopic and histological abnormalities in children undergoing first diagnostic endoscopy2 including 218 procedures in 164 children, of which 49.4% were macroscopically and histologically normal, and only 35% were histologically abnormal. The aim of this project was to assess how the Covid-19 pandemic affected diagnostic yields in paediatric endoscopy. Using the same methodology we analysed first diagnostic endoscopies over two 6-month periods: during the Covid-19 pandemic peak (including lockdowns), and two years later once restrictions were lifted. Clinical factors, endoscopic, and histological findings were assessed. Biopsies were reviewed in weekly histopathology multidisciplinary meetings with final agreed outcomes. Abnormal histology was used as the criterion standard for abnormality. During COVID-19: 69 procedures in 37 children. 65% (n=24) male. 86%(n=32) underwent OGD&Colon/Sigm, small numbers had OGD(n=3) or Colonoscopy(n=2) alone. Mean age 10.9 years. 89%(n=33) had histological abnormality. Macroscopic and histological abnormalities (respectively) were 94%&94% of those undergoing both OGD and colonoscopy (OGD&Col) plus 2 of 2 colonoscopy alone and 1 of 3 OGD alone. Post-Pandemic: 194 procedures in 138 children. 54% (n=75) male. 55%(n=76) underwent OGD; 41%(n=56) underwent OGD&Col/Sigm; 4%(n=6) Colon. Mean age 9.5 years. 66%(n=91) had histological abnormality. Macroscopic and histological abnormalities (respectively): 47%&61% of OGD, 50%&50% of colonoscopy alone, and 76%&78% in OGD&Col. Figure 1 shows the abnormality rates (defined by macroscopic and histologic abnormality), the% column for OGD or colonoscopy alone during Covid was not included due to n<3. The most common symptoms and laboratory tests prompting endoscopy were chronic diarrhoea (19%, n=26), rectal bleeding (20%, n=27), abdominal pain (33%, n=46), raised calprotectin (18%, n=25), positive TTG/EMA (17%, n=24), anaemia (20% of all negative TTG/EMA, n=23), and raised CRP/ESR (38% of all negative TTG/EMA, n=43). While clinical and laboratory abnormalities mostly correlated with high rates of macroscopic and histological abnormalities, features associated with low rates of macroscopic and histological abnormality were heartburn (38%&46% respectively) and dysphagia (44%&33% respectively). Features most predictive of macroscopic and histological abnormality (respectively) were chronic diarrhoea (88%&86%), rectal bleeding (70%&78%), raised calprotectin (88%&96%), anaemia (87%&91%), raised ESR (90%&100%), and raised CRP (86%&90%). Conclusions As expected, the number of first diagnostic endoscopies reduced greatly during the COVID-19 pandemic but post-pandemic returned to similar numbers to the previous study. There was a striking increase in histological abnormalities identified during the pandemic (from 35% of patients in 2014 to 84%). Post-pandemic this has remained high (66%), suggesting a lasting change in practice since the original study. No delayed diagnoses or patient complaints have been noted since this change. Further work will examine reasons for this.