Pediatric Elective Diagnostic Procedure Complications: A Multicenter Cohort Analysis

Attard, Thomas; Miller, Mikaela; Lee, Brian; Champion, Thomas W; Thomson, Mike

doi:10.1111/jgh.14318

Cited by 6 publications

(5 citation statements)

References 17 publications

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“…One large single center study of 9577 pediatric endoscopic procedures demonstrated a rate of adverse events (resulting in an unexpected hospital admission or medical intervention) of 0.26% following diagnostic procedures (6). Therapeutic procedures inherently carry a higher risk of adverse events with incidence varying with the procedure performed (6)(7)(8), with endoscopic dilatation, foreign body removal, and variceal ablation procedures more likely associated with adverse events (7).…”

Section: Discussionmentioning

confidence: 99%

Identification of Iatrogenic Perforation in Pediatric Gastrointestinal Endoscopy

Ledder

Woynarowski

Kamińska

et al. 2023

Journal of Pediatric Gastroenterology &Amp; Nutrition

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Objectives: Iatrogenic viscus perforation in pediatric gastrointestinal endoscopy (GIE) is a very rare, yet potentially life-threatening event. There are no evidence-based recommendations relating to immediate post-procedure follow-up to identify perforations and allow for timely management. This study aims to characterize the presentation of children with post-GIE perforation to better rationalize post-procedure recommendations. Methods: Retrospective study based on unrestricted pooled data from centers throughout Europe, North America, and the Middle East affiliated with the Endoscopy Special Interest Groups of European Society for Paediatric Gastroenterology Hepatology and Nutrition and North American Society for Pediatric Gastroenterology Hepatology and Nutrition. Procedural and patient data relating to clinical presentation of the perforation were recorded on standardized REDCap case-report forms. Results: Fifty-nine cases of viscus perforation were recorded [median age 6 years (interquartile range 3–13)]; 29 of 59 (49%) occurred following esophagogastroduodenoscopy, 26 of 59 (44%) following ileocolonoscopy, with 2 of 59 (3%) cases each following balloon enteroscopy and endoscopic retrograde cholangiopancreatography; 28 of 59 (48%) of perforations were identified during the procedure [26/28 (93%) endoscopically, 2/28 (7%) by fluoroscopy], and a further 5 of 59 (9%) identified within 4 hours. Overall 80% of perforations were identified within 12 hours. Among perforations identified subsequent to the procedure 19 of 31 (61%) presented with pain, 16 of 31 (52%) presented with fever, and 10 of 31 (32%) presented with abdominal rigidity or dyspnea; 30 of 59 (51%) were managed surgically, 17 of 59 (29%) managed conservatively, and 9 of 59 (15%) endoscopically; 4 of 59 (7%) patients died, all following esophageal perforation. Conclusions: Iatrogenic perforation was identified immediately in over half of cases and in 80% of cases within 12 hours. This novel data can be utilized to generate guiding principles of post-procedural follow-up and monitoring. PLAIN LANGUAGE SUMMARY Bowel perforation following pediatric gastrointestinal endoscopy is very rare with no evidence to base post-procedure follow-up for high-risk procedures. We found that half were identified immediately with the large majority identified within 12 hours, mostly due to pain and fever.

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Section: Discussionmentioning

confidence: 99%

Identification of Iatrogenic Perforation in Pediatric Gastrointestinal Endoscopy

Ledder

Woynarowski

Kamińska

et al. 2023

Journal of Pediatric Gastroenterology &Amp; Nutrition

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“…Much of the previous data on endoscopic AEs is derived from adult patients and may not be applicable to pediatrics 2,3 . Previous studies report a wide range of AE rates between 0.06% and 42% 4–12 . In 2010 the American Society for Gastrointestinal Endoscopy (ASGE) published terminology with regard to endoscopic AEs 13 .…”

Section: Introductionmentioning

confidence: 99%

“…2,3 Previous studies report a wide range of AE rates between 0.06% and 42%. [4][5][6][7][8][9][10][11][12] In 2010 the American Society for Gastrointestinal Endoscopy (ASGE) published terminology with regard to endoscopic AEs. 13 However, these definitions include events that are less common in the pediatric population (i.e., myocardial infarction, cerebrovascular events, deep vein thrombosis).…”

mentioning

confidence: 99%

Semiautomated electronic medical record based system for monitoring delayed adverse events in pediatric endoscopy and sedation

Wong,

Abazi,

Thielke

et al. 2024

J. pediatr. gastroenterol. nutr.

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ObjectiveTo develop a semiautomated electronic medical record (EMR) system to track pediatric endoscopic procedural adverse event (AE) at a tertiary referral children's hospital.MethodsWe developed an automated EMR based query for postprocedure AEs. Main outcome measurements within 30 days of procedure: return to emergency department, return to surgery, unplanned admissions and admissions with longer than intended stays. Events were graded using a recently described classification system for postendoscopy events and tracked for a 36‐month period, from January 2017 to December 2019.ResultsDevelopment of a semi‐automated system was successful in comprehensive identification of endoscopy and sedation related AE. A total of 193 AEs (2%) were identified in all three categories. Seventy cases (0.7%) were noted to be a direct result of an endoscopic procedure. Of these cases, 31 (44%) were noted to be Grade 3, 5 cases (7%) Grade 4, and no Grade 5 AE occured. Higher rates of AE were observed after therapeutic procedures versus diagnostic (2.6% vs. 0.3%, p = <0.00001). AEs related to sedation occurred in 0.5% of procedures with the majority (84%) reported in patients with American Society of Anesthesia classification of 3 or greater.ConclusionsDiagnostic endoscopy remains a safe procedure and risk of both endoscopy and sedation related AE are low. Therapeutic procedures carry a higher risk but are still overwhelmingly safe. Institutional investment in this EMR based system allowed for sustainability and comprehensive tracking of endoscopy related AE.

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“…Events were more frequent in those less than 5 years of age and in those with obesity or lower respiratory disease. Lastly, a study of 217,817 children undergoing endoscopy which utilized the Pediatric Health Information System (PHIS) database found that 0.05% were admitted to the hospital and that 0.60% of patients presented to the emergency department following elective endoscopy [20]. One-half of these were for gastrointestinal symptoms.…”

Section: Introductionmentioning

confidence: 99%

The Evolving Role of Mucosal Histology in the Evaluation of Pediatric Functional Dyspepsia: A Review

Friesen

Colombo

Schurman³

2019

Gastrointestinal Disorders

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Although not required to establish the diagnosis, endoscopy with mucosal biopsy is commonly performed in the evaluation of children with dyspepsia. Traditionally, esophagogastroduodenoscopy (EGD) has been performed in children with abdominal pain to identify pathology or conversely, to “rule-out” organic disease in order to establish a diagnosis of FD. In this review, we discuss the current diagnostic yield of endoscopically-obtained biopsies in identifying disease in children and adolescents with dyspepsia including an expanded discussion of common histologic diagnoses where clinical significance has not been definitively established. In turn, we discuss the transition of endoscopy from a search for disease to a search for biologic contributors to symptom generation, while considering the growing evidence linking non-diagnostic mucosal inflammation to FD, specifically mast cells and eosinophils.

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Pediatric Elective Diagnostic Procedure Complications: A Multicenter Cohort Analysis

Abstract: Ambulatory pediatric endoscopy is safe; significant adverse outcomes are rare but more likely in female, non-White or Hispanic patients and in patients with significant chronic comorbidities.

Cited by 6 publications

References 17 publications

Identification of Iatrogenic Perforation in Pediatric Gastrointestinal Endoscopy

Identification of Iatrogenic Perforation in Pediatric Gastrointestinal Endoscopy

Semiautomated electronic medical record based system for monitoring delayed adverse events in pediatric endoscopy and sedation

The Evolving Role of Mucosal Histology in the Evaluation of Pediatric Functional Dyspepsia: A Review

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