The role of endoscopy in pediatric gastrointestinal bleeding
| Autor: | Andreas Fischer, Dirk Bausch, Markus Franke, Hans-Jürgen Richter-Schrag, Andrea Geiß, Ulrich F. Wellner, Peter Greiner |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2016 |
| Předmět: |
medicine.medical_specialty
Gastrointestinal bleeding Original article Lower gastrointestinal bleeding medicine.diagnostic_test business.industry Esophagogastroduodenoscopy Colonoscopy medicine.disease Gastroenterology Hematochezia Endoscopy 03 medical and health sciences 0302 clinical medicine Melena 030225 pediatrics Internal medicine Medicine 030211 gastroenterology & hepatology Pharmacology (medical) lcsh:Diseases of the digestive system. Gastroenterology Upper gastrointestinal bleeding medicine.symptom lcsh:RC799-869 business |
| Zdroj: | Endoscopy International Open, Vol 04, Iss 09, Pp E1011-E1016 (2016) Endoscopy International Open |
| ISSN: | 2196-9736 2364-3722 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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