Outcomes and diagnostic yield of paediatric gastrointestinal endoscopy: implications for patient selection, benchmarking and quality standards

Objective To report updated diagnostic yield in children undergoing first diagnostic gastrointestinal endoscopy, compared with previous periods reflecting earlier routine practice and during COVID-19 pandemic-related service restrictions. Secondary aims were to study clinical and laboratory predictive factors for abnormal paediatric endoscopy and to consider their implications for patient selection, benchmarking and quality standards. Design Retrospective cross-sectional analysis of all first-diagnostic endoscopies performed in a tertiary paediatric gastroenterology service across three 6-month cohorts: Period 1—historic routine practice; Period 2—during COVID-19 pandemic and Period 3—contemporary routine practice. Assessment of endoscopic findings and preceding clinical and laboratory factors for sensitivity, specificity, negative and positive predictive value. Primary outcome Diagnostic yield defined as the % of patients with histological abnormality confirmed in our weekly histology multidisciplinary team meeting. Secondary outcome Macroscopic and histological findings on endoscopy and presenting clinical and laboratory measures. Results During Period 2, yield reached 89% for oesophagogastroduodenoscopy (OGD) and ileocolonoscopy. In Period 3, there were 194 procedures in 137 children. Period 3 histological abnormality rates were significantly higher than Period 1: 66.4% versus 36% overall; 61.3% versus 28% for OGD; 54.9% versus 16% for OGD alone (in patients with normal anti-transglutaminase IgA antibody); 75% versus 47% for OGD and ileocolonoscopy. Period 3 unexpectedly demonstrated a significant increase in diagnoses of histological gastritis. Conclusions Refined patient selection can reduce the proportion of normal procedures, with no observed evidence of harm. These data can contribute towards benchmarking and development of quality standards for paediatric diagnostic endoscopy services.