Sub-10-minute High-quality Diagnostic Colonoscopy With Terminal Ileum Intubation in Children Is Feasible and Safe
| Autor: | Nikhil Thapar, Miranda Eyles, Sara Isoldi, Neil P. Shah, Angelo D’Ambrosio, Sonny K. F. Chong, Muftha Eltumi, Mike Thomson, Chaaya Singh, Babu Vadamalayan |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Diarrhea
Male medicine.medical_specialty Abdominal pain Time Factors pediatrics Adolescent medicine.medical_treatment Colonoscopy quality assurance Inflammatory bowel disease 03 medical and health sciences 0302 clinical medicine diagnostic yield ileocolonoscopy insertion time terminal ileum intubation Ileum 030225 pediatrics medicine Terminal ileum Humans Intubation Outpatient clinic Prospective Studies Child Prospective cohort study medicine.diagnostic_test business.industry Age Factors Gastroenterology Infant Inflammatory Bowel Diseases medicine.disease Occult Abdominal Pain Surgery Rectal Diseases medicine.anatomical_structure Child Preschool Pediatrics Perinatology and Child Health Female 030211 gastroenterology & hepatology medicine.symptom Gastrointestinal Hemorrhage business |
| Zdroj: | Journal of Pediatric Gastroenterology & Nutrition. 69:6-12 |
| ISSN: | 1536-4801 0277-2116 |
| Popis: | Objectives To critically appraise ileocolonoscopy (IC) practice in a large tertiary center, where IC is exclusively performed by experienced pediatric colonoscopists, particularly focusing on indications for the procedure; bowel preparation efficacy; IC completion rates and timings; diagnostic yield; and complications. Patients and methods We prospectively evaluated all patients referred to our clinic between July 2015 and June 2016. Data on age, height and weight, sex, surgical history, indications for colonoscopy, bowel preparation given, and bowel cleansing efficacy were collected. The following were calculated: percentage of terminal ileal (TI) intubation; time to terminal ileum; total duration of each procedure. In addition, we evaluated the number and the type of complications encountered and the number of patients readmitted within 30 days from the elective procedure. Endoscopic diagnostic yield, stratified for indication, was calculated. Results A total of 1392 patients were referred; 181 required an endoscopic evaluation of the lower gastrointestinal (GI) tract (Outpatient Department conversion rate: 13%). Main indications for IC were: recurrent abdominal pain 38.1%; unexplained chronic diarrhea 16%; suspected inflammatory bowel disease (IBD) 24.9%; isolated rectal bleeding 13.2%; occult GI bleeding 1.6%; unexplained faltering growth 1.6%; IBD restaging 2.6%; and miscellaneous 1.6%. Terminal ileum was reached in all the patients (TI intubation rate = 100%). Median time to TI was 9.8 minutes (1-50 minutes). Time to TI was lower in younger patients compared to older ones (P = 0.005). Bowel cleansing was judged as grade 1 in 49.2%; grade 2 in 33.7%; grade 3 in 13.3%; and grade 4 in 3.9%. A significant statistical correlation was recorded between bowel cleansing and time to TI. The positive diagnostic yield was: 11.6% in patients with abdominal pain; 37.9% in patients with chronic diarrhea; 51.1% in patients with suspected IBD; 29.2% in patients with isolated rectal bleeding; 33.3% in patients with occult GI bleeding; 0% in patients with faltering growth; and 33% in the miscellaneous group. Conclusions In conclusion, appropriately targeted IC in the management of children with GI symptoms is a safe, fast, and useful investigation. TI intubation rates of 100% are achievable and desirable and can be conducted quickly. Poor bowel preparation impacts negatively on this and IC duration may be faster in younger children. High diagnostic yields have been recorded in patients with a clinical suspicion of IBD. Diagnostic yield in isolated recurrent abdominal pain is low. Training to excellence in pediatric IC should be a persistent goal. |
| Databáze: | OpenAIRE |
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