Algorithm Based Decision Making In Paediatric Endoscopy

Aims To retrospectively and prospectively assess diagnostic and therapeutic endoscopies performed in children in a single unit.

To investigate and analyse indications with the histological outcome of newly presenting and follow-up cases.

To predict the histological outcome of an endoscopy based on clinical presentation and investigations.

Methods This was a 3-months retrospective and 1-month prospective analysis of clinical factors with endoscopic and histological outcome in a single centre of UK. All the diagnostic and therapeutic cases, whether new cases or follow-up cases, were included in this study. Histological outcome was considered as a standard criterion for abnormality as agreed in the weekly multidisciplinary team meeting.

Results A total of 162 endoscopy cases were reviewed. 151 diagnostic and 11 therapeutic procedure’s data was collected. 32 % of the diagnostic cases and 36 % of the diagnostic procedures were histologically normal. 129 (85 %) of the diagnostic cases were correctly predicted without the knowledge of the outcome of the endoscopy or biopsy report. 82 % of new normal cases were predicted accurately. 40 % of new endoscopies had normal histology. 60 % of the OGDs in this study had normal histological outcome.

Abdominal pain was the symptom-indicator in 44 % of diagnostic cases. However, 57 % of abdominal pain cases had normal histological outcome in OGDs. Weight loss and anaemia reported a high abnormal outcome of 89 % and 92 %, respectively.

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Conclusions This study reported almost one third of normal histological outcome of paediatric endoscopies. More than half of OGD were normal studies with no pathology on biopsy. Prediction of outcome of endoscopy on basis of clinical presentation was successfully performed in both aspects of this studies and both new and follow-up cases. This study provides data to design an algorithm using clinical presentation and laboratory data to predict endoscopic outcome and it will also help in the reduction of unnecessary endoscopies.

Citation Ahmad WT eP462 ALGORITHM BASED DECISION MAKING IN PAEDIATRIC ENDOSCOPY. Endoscopy 2021; 53: S249.