Decreased Relative Diagnostic Yield of Esophagogastroduodenoscopy in Children With Gastroparesis

Abstract

Background Esophagogastroduodenoscopy (EGD) and gastric emptying scintigraphy (GES) are commonly performed in the evaluation of children with upper gastrointestinal (GI) symptoms. It has been presumed, but not clarified, that gastroparesis increases the likelihood of identifying abnormalities on EGD. We sought to determine whether the presence of gastroparesis influenced the diagnostic yield of EGD in children. Methods We conducted a retrospective chart review of children who underwent both an EGD and gastric emptying scintigraphy (GES) within 3 months of each other for evaluation of upper GI symptoms (e.g. abdominal pain). Clinical history (symptoms, comorbidities, medications, and surgical procedures), GES results, and EGD histology reports were captured. Results 125 children (46% female) were included, of whom, 70 (56%) had gastroparesis. 33 (26%) children had liquid-meal GES (1.2 ± 1.1 years of age, mean ± SD) and 92 (64%) had solid-meal GES (12.4 ± 3.6 years of age). There was an overall trend toward a decreased frequency of biopsy abnormalities in those with gastroparesis (P=0.09). Those with gastroparesis identified via liquid-meal GES were less likely to have reflux esophagitis on biopsy (P=0.002). Those with gastroparesis identified on solid-meal GES were less likely to have gastritis (P=0.04). Symptoms, comorbidities, or medications were not predictive of GES or EGD results. Conclusions Children with gastroparesis may be less likely to have biopsy abnormalities identified on EGD in comparison to those without gastroparesis. Further prospective, larger, and multicenter studies are needed to validate our findings.

Yield of Endoscopy in Pediatric Gastroparesis

“…The data showed that patients evaluated for gastroparesis (those with dyspeptic symptoms such as nausea, vomiting, bloating, and abdominal pain) have a high rate of findings on endoscopy, regardless of gastric emptying. The difference between the 2 groups was not statistically significant, a finding in contrast to recently published work by Wong et al (8), who suggested that the yield of endoscopy was actually greater in children with normal gastric emptying than in those with gastroparesis. There was no discernible effect of the order of testing on rates of diagnosis of gastroparesis or rates of positive findings on endoscopy in this population.…”

Update on pediatric gastroparesis: A review of the published literature and recommendations for future research

“…An upper endoscopy may be performed to evaluate for gastric outlet obstruction and mucosal disease. Although a significant portion may have abnormal endoscopic findings, two pediatric studies found low yield of endoscopy in children with gastroparesis compared to non‐gastroparetic controls . Yet, practice guidelines by the American Society for Gastrointestinal Endoscopy suggest endoscopic evaluation to exclude a structural abnormality in children suspected to have gastroparesis who do not have a clear diagnosis after imaging studies …”

“…Although a significant portion may have abnormal endoscopic findings, two pediatric studies found low yield of endoscopy in children with gastroparesis compared to non-gastroparetic controls. 114,115…”

Childhood gastroparesis is a unique entity in need of further investigation

“…These two studies argue for endoscopy in these patients given the relatively high prevalence of positive histological findings. In contrast, Wong et al found that children with GP had fewer abnormal histological findings (27%, 19/70) when compared to children with normal gastric emptying (42%, 23/55), with gastritis and esophagitis also being the most common findings in the latter group. Whether the abnormal findings in children with GP contribute to the delay in gastric emptying is unclear.…”