The utility and safety of paediatric endoscopy in a district general hospital in Southeast England

Abstract

This study was done to evaluate the appropriateness, diagnostic yield, and quality of paediatric gastrointestinal endoscopy in a large DGH with tertiary paediatric gastroenterology services. It was a retrospective cohort study of children who had at least one gastrointestinal endoscopy during 31 months (May 2018-Dec 2020) in a district general hospital in Southeast England. The participants were children (2–17 years). Two hundred ninety-three procedures were performed in total, 80% were diagnostic and 20% for surveillance. The median age was 12 years and 52.5% were males. Oesophago-gastro-duodenoscopy (OGD) corresponded to 79.5% of procedures, ileo-colonoscopy (IC) to 7.2% and the remaining had both procedures. The main diagnostic indication was persistent abdominal pain in 33.5% of cases, followed by suspected GORD (14.8%), recurrent vomiting (14.3%), dysphagia (9.1%) and blood loss per rectum (8.6%). A total of 64.7% showed abnormal macroscopic findings, and 69.2% showed histopathological signs of disease. The most common histological diagnosis was gastritis in 23% followed by coeliac disease in 13%, reflux oesophagitis in 12.2% and inflammatory bowel disease in 9.6%. Procedures were performed with utmost safety with two reported cases of complications, which were appropriately managed. The completion rate of diagnostic IC was 87%. A waiting time of 6 weeks was achieved in 50.4% of cases. Conclusion : Paediatric endoscopy can be safely performed in a district general hospital with the right setup and can aid in the management of gastrointestinal disease in the paediatric patient. It is important to monitor and regularly audit such practices to improve the quality of specialist services. What is Known: • Paediatric endoscopy is predominantly performed in large tertiary centres and included in the diagnostic algorithm for many paediatric gastrointestinal conditions. • There are recommendations on clinical indication endorsed by ESPGHAN and key quality indicators published jointly by JAG and BSPGHAN . What is New: • Paediatric endoscopy can be appropriately and safely performed in district general hospital by trained professionals, decreasing the workload in larger tertiary paediatric centres. • Adoption of regular audit practices is essential to ensure and improve quality and appropriateness of this specialist service.

Management patterns of multiple magnet ingestion reported to New Jersey Poison Information and Education System

“…Clinically significant complications of multiple magnet ingestions may arise in up to one in 10 cases 4 while pediatric endoscopies can be done effectively and safely with a minor complication rate as low as 0.68%. 5 This risk-benefit equation favors early intervention whenever possible and is consistent with already published specialty guidelines. 1,3,6 Prudent healthcare resource allocation is another consideration in the management of these cases.…”

“…Based on the complication rates of multiple magnets ingestion in the literature reviewed and the relatively high rate of success in removing magnets from the stomach with timely emergent EGD as described in this limited case series, the benefit of early intervention likely outweighs the possibility of abdominal complication with expectant management when magnets are amenable for removal via EGD at initial presentation. Clinically significant complications of multiple magnet ingestions may arise in up to one in 10 cases 4 while pediatric endoscopies can be done effectively and safely with a minor complication rate as low as 0.68% 5 . This risk–benefit equation favors early intervention whenever possible and is consistent with already published specialty guidelines 1,3,6 …”

[Retracted] Clinical Comparison of Endoscopic Ultrasonography and CT in Preoperative TN Staging of Esophagogastric Junction Cancer

“…In general, the higher the ultrasound frequency is, the higher the detection resolution will be. However, the lower the ultrasound frequency is, the worse the detection resolution will be, but the greater the depth and breadth will be [13].…”

“…In (13), ΔMsg k ij represents the pheromone left between the pixel points i and j when the k-th ant changes from time t to time t + n. e formula is expressed as follows:…”

Endoscopia digestiva superior en pediatría: experiencia de un centro de alta complejidad de Latinoamérica

“…y cols. reportaron una tasa de complicaciones del 0,7% en los procedimientos terapéuticos 29,30 . La tasa de complicaciones anestésicas es < 2% y los pacientes con comorbilidades son los que tienen mayor riesgo 31 , hallazgos que concuerdan con nuestra población de estudio tanto en la tasa de presentación como las características clínicas de los pacientes afectados.…”