The role of endoscopy in pediatric gastrointestinal bleeding

Abstract

Background and study aims: Gastrointestinal bleeding in children and adolescents accounts for up to 20 % of referrals to gastroenterologists. Detailed management guidelines exist for gastrointestinal bleeding in adults, but they do not encompass children and adolescents. The aim of this study was to assess gastrointestinal bleeding in pediatric patients and to determine an investigative management algorithm accounting for the specifics of children and adolescents. Patients and methods: Pediatric patients with gastrointestinal bleeding admitted to our endoscopy unit from 2001 to 2009 (n = 154) were identified. Retrospective statistical and neural network analysis was used to assess outcome and to determine an investigative management algorithm. Results: The source of bleeding could be identified in 81 % (n = 124/154). Gastrointestinal bleeding was predominantly lower gastrointestinal bleeding (66 %, n = 101); upper gastrointestinal bleeding was much less common (14 %, n = 21). Hematochezia was observed in 94 % of the patients with lower gastrointestinal bleeding (n = 95 of 101). Hematemesis (67 %, n = 14 of 21) and melena (48 %, n = 10 of 21) were associated with upper gastrointestinal bleeding. The sensitivity and specificity of a neural network to predict lower gastrointestinal bleeding were 98 % and 63.6 %, respectively and to predict upper gastrointestinal bleeding were 75 % and 96 % respectively. The sensitivity and specifity of hematochezia alone to predict lower gastrointestinal bleeding were 94.2 % and 85.7 %, respectively. The sensitivity and specificity for hematemesis and melena to predict upper gastrointestinal bleeding were 82.6 % and 94 %, respectively. We then developed an investigative management algorithm based on the presence of hematochezia and hematemesis or melena. Conclusions: Hematochezia should prompt colonoscopy and hematemesis or melena should prompt esophagogastroduodenoscopy. If no source of bleeding is found, additional procedures are often non-diagnostic.

Nguyên Nhân Và Đặc Điểm Lâm Sàng Của Xuất Huyết Tiêu Hoá Dưới Ở Trẻ Em Tại Bệnh Viện Nhi Trung Ương

“…Tuổi trung bình là 5,5 ± 4,6 tuổi (Bảng 1). Kết quả này khá tương đồng với nghiên cứu trước đó của Lê Quang Quỳnh (2017) là 5,90 ± 3,52 3 và thấp hơn nghiên cứu của Markus Frankel là 7,55 5 . Sự khác biệt này là do trong nghiên cứu của chúng tôi có trên 50% bệnh nhân chẩn đoán polyp đại trực tràng, đây là bệnh lý thường gặp ở lứa tuổi này.…”

Gastrointestinal symptoms in children: Primary care and specialist interface

“…Visual inspection of the perianal area and digital rectal examination should always be considered in the case of haematochezia, to detect the possibility of anal fissure (frequent sign of constipation), streptococcal cryptitis or rectal polyp . Endoscopy is the method of choice for the localisation of GIB in paediatric patients . Haematochezia requires colonoscopy if it lasts more than 1 week or recurs (twice a week for 4 weeks or 3 times per month for 3 months) …”

“…Endoscopy is the method of choice for the localisation of GIB in paediatric patients . Haematochezia requires colonoscopy if it lasts more than 1 week or recurs (twice a week for 4 weeks or 3 times per month for 3 months) …”

Diagnostic yield of esophagogastroduodenoscopy in upper gastrointestinal bleeding in pediatrics: a cross-sectional study at a tertiary center

“…Gastrointestinal bleeding (GIB) during infancy and childhood is common and accounts for up to 20 % of referrals to pediatric gastroenterologists [2].…”