Melissa A Sheiko1, James A Feinstein2, Kelley E Capocelli3, Robert E Kramer4. 1. Department of Pediatrics, Digestive Health Institute, University of Colorado Denver School of Medicine, Aurora, Colorado, USA. 2. Children's Outcomes Research Program, Children's Hospital Colorado, University of Colorado Denver School of Medicine, Aurora, Colorado, USA. 3. Department of Pathology, University of Colorado Denver School of Medicine, Aurora, Colorado, USA. 4. Department of Pediatrics, University of Colorado Denver School of Medicine, Aurora, Colorado, USA.
Abstract
BACKGROUND: Pediatric gastroenterologists frequently perform routine endoscopic biopsies despite normal-appearing mucosa during EGD. Older small studies have supported this practice. OBJECTIVE: To re-evaluate the concordance between endoscopic appearance and histology in the era of high-definition endoscopy. DESIGN: Retrospective cohort study. SETTING: Single tertiary care center. PATIENTS: A total of 1000 pediatric patients undergoing initial EGD. MAIN OUTCOME MEASUREMENTS: Endoscopic and histologic findings. RESULTS: The overall rate of an endoscopic finding was 34.7%, which was 40.4% of a histologic finding. Concordance between the presence of any endoscopic finding and any histologic finding in all locations was 69.9% (Cohen's κ coefficient=0.32). In the esophagus, the concordance between any endoscopic finding and any histologic finding was 82.6% (κ=0.45). The stomach was 73.2% concordant (κ=0.18), and the duodenum was 89.3% concordant (κ=0.42). The κ coefficient decreased when comparing specific findings in each location; it was 0.34 in the esophagus, 0.17 in the stomach, and 0.34 in the duodenum. If biopsy specimens had only been obtained when the endoscopist identified abnormal mucosa, 48.5% of the pathologic findings would have been missed. In patients with histology consistent with eosinophilic esophagitis, 30.2% had normal-appearing mucosa. For celiac disease, 43% had normal-appearing mucosa. In the stomach, an abnormal endoscopic appearance was more likely to have normal histology. LIMITATIONS: The single-center, retrospective nature and more endoscopists than pathologists. CONCLUSIONS: These data support the routine collection of biopsy specimens in the duodenum, stomach, and esophagus during EGD in pediatric patients.
BACKGROUND: Pediatric gastroenterologists frequently perform routine endoscopic biopsies despite normal-appearing mucosa during EGD. Older small studies have supported this practice. OBJECTIVE: To re-evaluate the concordance between endoscopic appearance and histology in the era of high-definition endoscopy. DESIGN: Retrospective cohort study. SETTING: Single tertiary care center. PATIENTS: A total of 1000 pediatric patients undergoing initial EGD. MAIN OUTCOME MEASUREMENTS: Endoscopic and histologic findings. RESULTS: The overall rate of an endoscopic finding was 34.7%, which was 40.4% of a histologic finding. Concordance between the presence of any endoscopic finding and any histologic finding in all locations was 69.9% (Cohen's κ coefficient=0.32). In the esophagus, the concordance between any endoscopic finding and any histologic finding was 82.6% (κ=0.45). The stomach was 73.2% concordant (κ=0.18), and the duodenum was 89.3% concordant (κ=0.42). The κ coefficient decreased when comparing specific findings in each location; it was 0.34 in the esophagus, 0.17 in the stomach, and 0.34 in the duodenum. If biopsy specimens had only been obtained when the endoscopist identified abnormal mucosa, 48.5% of the pathologic findings would have been missed. In patients with histology consistent with eosinophilic esophagitis, 30.2% had normal-appearing mucosa. For celiac disease, 43% had normal-appearing mucosa. In the stomach, an abnormal endoscopic appearance was more likely to have normal histology. LIMITATIONS: The single-center, retrospective nature and more endoscopists than pathologists. CONCLUSIONS: These data support the routine collection of biopsy specimens in the duodenum, stomach, and esophagus during EGD in pediatric patients.