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01-04-2021 | Endoscopy | Original Article

Are biopsies always necessary in upper and lower gastrointestinal endoscopy in children? A retrospective 10-year analysis

Authors: Rodrigo Corsato Scomparin, Pedro Luiz Toledo De Arruda Lourencao, Giovana Tuccile Comes, Wilson Elias De Oliveira Junior, Marcos Curcio Angelini, Paulo Cezar Haddad de Amorim, Simone Antunes Terra, Maria Aparecida Marchesan Rodrigues, Erika Veruska Paiva Ortolan

Published in: European Journal of Pediatrics | Issue 4/2021

Abstract

Little attention has been given to the efficiency and validity of performing routine endoscopic biopsies in normal areas in children. This study aimed to investigate the need to perform routine biopsies in upper gastrointestinal endoscopy (UDE) and colonoscopy in normal areas by comparing macroscopy and histology. It was a 10-year retrospective analysis with the inclusion of 761 UDEs and 177 colonoscopies. Considering all segments, UDEs showed false-positive result rates of 73.11% and false-negative result rates of 14.34%. The histological results modified the initial management in 53.95% of patients. Considering all segments, colonoscopies showed false-positive result rates of 63.64% and false-negative result rates of 30.97%. The histological results modified the initial management in 34.45% of patients.

Conclusion: If biopsies were obtained only in abnormal areas, the diagnosis would be lost in 53.95% of the patients in upper endoscopies and 85.7% of the colonoscopies, which justifies routine maintenance of biopsies in macroscopically normal areas in children.

What is Known:

• Little attention has been given to the efficiency and validity of endoscopic biopsies of normal areas during pediatric exams.

• Only a few pediatric studies have correlated macroscopic and histological findings from endoscopic biopsies, and low sensitivity and specificity, as well as poor agreement, were reported.

What is New:

• Our study confirms the evidence that routine biopsies from macroscopically normal areas during upper and lower digestive endoscopies can lead to histopathological diagnoses and different medical management.

• This is the first research on this topic in a Latin population, from a developing country, reassuring the results obtained in previous papers from other countries.

Sheiko MA, Feinstein JA, Capocelli KE, Kramer RE (2015) The concordance of endoscopic and histologic findings of 1000 pediatric EGDs. Gastrointest Endosc 81(6):1385–1391. http://www.ncbi.nlm.nih.gov/pubmed/25440693

Kori M, Gladish V, Ziv-Sokolovskaya N, Huszar M, Beer-Gabel M, Reifen R (2003) The significance of routine duodenal biopsies in pediatric patients undergoing upper intestinal endoscopy. J Clin Gastroenterol 37(1):39–41. http://www.ncbi.nlm.nih.gov/pubmed/12811207

ASGE STANDARDS OF PRACTICE COMMITTEE, Lee KK, Anderson MA, Baron TH, Banerjee S, Cash BD et al (2008) Modifications in endoscopic practice for pediatric patients. Gastrointest Endosc 67(1):1–9. http://www.ncbi.nlm.nih.gov/pubmed/18155419

Lightdale JR, Acosta R, Shergill AK, Chandrasekhara V, Chathadi K, Early D et al (2014) Modifications in endoscopic practice for pediatric patients. Gastrointest Endosc 79(5):699–710. https://linkinghub.elsevier.com/retrieve/pii/S0016510713022979

Tringali A, Thomson M, Dumonceau J-M, Tavares M, Tabbers M, Furlano R, Spaander M, Hassan C, Tzvinikos C, Ijsselstijn H, Viala J, Dall’Oglio L, Benninga M, Orel R, Vandenplas Y, Keil R, Romano C, Brownstone E, Hlava Š, Gerner P, Dolak W, Landi R, Huber W, Everett S, Vecsei A, Aabakken L, Amil-Dias J, Zambelli A (2016) Pediatric gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) and European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) Guideline Executive summary. Endoscopy 49(01):83–91. http://www.thieme-connect.de/DOI/DOI?10.1055/s-0042-111002

Badizadegan K, Thompson KM (2011) Value of information in nonfocal colonic biopsies. J Pediatr Gastroenterol Nutr 53(6):679–683. http://www.ncbi.nlm.nih.gov/pubmed/21681109

Cohen JF, Korevaar DA, Altman DG, Bruns DE, Gatsonis CA, Hooft L et al (2016) STARD 2015 guidelines for reporting diagnostic accuracy studies: explanation and elaboration. BMJ Open 6(11):e012799. http://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2016-012799

Hummel TZ, ten Kate FJW, Reitsma JB, Benninga MA, Kindermann A (2012) Additional value of upper GI tract endoscopy in the diagnostic assessment of childhood IBD. J Pediatr Gastroenterol Nutr 54(6):753–757. http://www.ncbi.nlm.nih.gov/pubmed/22584746

Thakkar K, Dorsey F, Gilger MA (2011) Impact of endoscopy on management of chronic abdominal pain in children. Dig Dis Sci 56(2):488–493. http://www.ncbi.nlm.nih.gov/pubmed/20596777

10.

Thakkar K, Chen L, Tessier ME, Gilger MA (2014) Outcomes of children after esophagogastroduodenoscopy for chronic abdominal pain. Clin Gastroenterol Hepatol 12(6):963–969. https://linkinghub.elsevier.com/retrieve/pii/S1542356513012962

11.

Thakkar K, Lucia CJ, Ferry GD, McDuffie A, Watson K, Tsou M et al (2009) Repeat endoscopy affects patient management in pediatric inflammatory bowel disease. Am J Gastroenterol 104(3):722–727. http://www.ncbi.nlm.nih.gov/pubmed/19209163

12.

Thakkar K, Gilger MA, Shulman RJ, El Serag HB (2007) EGD in children with abdominal pain: a systematic review. Am J Gastroenterol 102(3):654–661. http://www.ncbi.nlm.nih.gov/pubmed/17222318

13.

Shah A, Kagalwalla AF, Gonsalves N, Melin-Aldana H, Li BUK, Hirano I (2009) Histopathologic variability in children with eosinophilic esophagitis. Am J Gastroenterol 104(3):716–721. http://www.nature.com/articles/ajg2008117

14.

Gonsalves N, Policarpio-Nicolas M, Zhang Q, Rao MS, Hirano I (2006) Histopathologic variability and endoscopic correlates in adults with eosinophilic esophagitis. Gastrointest Endosc 64(3):313–319. http://www.ncbi.nlm.nih.gov/pubmed/16923475

15.

Papadopoulou A, Koletzko S, Heuschkel R, Dias JA, Allen KJ, Murch SH, Chong S, Gottrand F, Husby S, Lionetti P, Mearin ML, Ruemmele FM, Schäppi MG, Staiano A, Wilschanski M, Vandenplas Y (2014) Management guidelines of eosinophilic esophagitis in childhood. J Pediatr Gastroenterol Nutr 58(1):107–118. http://journals.lww.com/00005176-201401000-00027

16.

Lucendo AJ, Molina-Infante J, Arias Á, von Arnim U, Bredenoord AJ, Bussmann C, Amil Dias J, Bove M, González-Cervera J, Larsson H, Miehlke S, Papadopoulou A, Rodríguez-Sánchez J, Ravelli A, Ronkainen J, Santander C, Schoepfer AM, Storr MA, Terreehorst I, Straumann A, Attwood SE (2017) Guidelines on eosinophilic esophagitis: evidence-based statements and recommendations for diagnosis and management in children and adults. United European Gastroenterol J 5(3):335–358. https://doi.org/10.1177/2050640616689525CrossRefPubMedPubMedCentral

17.

Nielsen JA, Lager DJ, Lewin M, Rendon G, Roberts CA (2014) The optimal number of biopsy fragments to establish a morphologic diagnosis of eosinophilic esophagitis. Am J Gastroenterol 109(4):515–520. http://www.ncbi.nlm.nih.gov/pubmed/24445569

18.

Salek J, Clayton F, Vinson L, Saffari H, Pease LF, Boynton K et al (2015) Endoscopic appearance and location dictate diagnostic yield of biopsies in eosinophilic oesophagitis. Aliment Pharmacol Ther 41(12):1288–1295. http://www.ncbi.nlm.nih.gov/pubmed/25898774

19.

Shah A, Kagalwalla AF, Gonsalves N, Melin-Aldana H, Li BUK, Hirano I (2009) Histopathologic variability in children with eosinophilic esophagitis. 104(3, 21):716–Am J Gastroenterol. http://www.ncbi.nlm.nih.gov/pubmed/19209168

20.

Husby S, Koletzko S, Korponay-Szabó I, Kurppa K, Mearin ML, Ribes-Koninckx C, Shamir R, Troncone R, Auricchio R, Castillejo G, Christensen R, Dolinsek J, Gillett P, Hróbjartsson A, Koltai T, Maki M, Nielsen SM, Popp A, Størdal K, Werkstetter K, Wessels M (2020) European Society Paediatric Gastroenterology, Hepatology and Nutrition Guidelines for Diagnosing Coeliac Disease 2020. J Pediatr Gastroenterol Nutr 70(1):141–156. https://doi.org/10.1097/MPG.0000000000002497

21.

North American Society for Pediatric Gastroenterology, Hepatology and N, Colitis Foundation of America, Bousvaros A, Antonioli DA, Colletti RB, Dubinsky MC et al (2007) Differentiating ulcerative colitis from Crohn disease in children and young adults: report of a working group of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the Crohn’s and Colitis Foundation of America. J Pediatr Gastroenterol Nutr 44(5):653–674. http://www.ncbi.nlm.nih.gov/pubmed/17460505

22.

da Silva JGN, De Brito T, Cintra Damião AOM, Laudanna AA, Sipahi AM (2006) Histologic study of colonic mucosa in patients with chronic diarrhea and normal colonoscopic findings. J Clin Gastroenterol 40(1):44–48. http://www.ncbi.nlm.nih.gov/pubmed/16340633

23.

Sanderson IR, Boyle S, Williams CB, Walker-Smith JA (1986) Histological abnormalities in biopsies from macroscopically normal colonoscopies. Arch Dis Child 61(3):274–277. https://doi.org/10.1136/adc.61.3.274CrossRefPubMedPubMedCentral

24.

Manfredi MA, Jiang H, Borges LF, Deutsch AJ, Goldsmith JD, Lightdale JR (2014) Good agreement between endoscopic findings and biopsy reports supports limited tissue sampling during pediatric colonoscopy. J Pediatr Gastroenterol Nutr 58(6):773–778. http://www.ncbi.nlm.nih.gov/pubmed/24464229

25.

Beer KD, Collier SA, Du F, Gargano JW (2017) Giardiasis diagnosis and treatment practices among commercially insured persons in the United States. Clin Infect Dis 64(9):1244–1250. https://doi.org/10.1093/cid/cix138CrossRefPubMedPubMedCentral

26.

Winter H, Heyman M (2014) Value of endoscopic mucosal biopsies in normal-appearing colonic mucosa. J Pediatr Gastroenterol Nutr 58(6):676–677. http://www.ncbi.nlm.nih.gov/pubmed/24866780

27.

Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33(1):159–174. http://www.ncbi.nlm.nih.gov/pubmed/843571

28.

Saeed A, Assiri A, Cheema H (2019) Celiac disease in children. J Nat Sci Med 2(1):23. http://www.jnsmonline.org/text.asp?2019/2/1/23/242164

29.

Caio G, Volta U, Sapone A, Leffler DA, De Giorgio R, Catassi C et al (2019) Celiac disease: a comprehensive current review. BMC Med 17(1):142. https://doi.org/10.1186/s12916-019-1380-zCrossRefPubMedPubMedCentral

30.

Chou R, Bougatsos C, Blazina I, Mackey K, Grusing S, Selph S (2017) Screening for celiac disease. JAMA 317(12):1258. https://doi.org/10.1001/jama.2016.10395CrossRefPubMed

31.

Coca DS, Santos CM, de Oliveira OSG, Dayse Aparício Pereira CKFJ, Artifon ELA (2018) Upper gastrointestinal endoscopy applied in pediatrics: endoscopic and histological findings, including Helicobacter pylori. Rev Gastroenterol Peru 38(1):40–43. http://www.scielo.org.pe/pdf/rgp/v38n1/a06v38n1.pdf

32.

Wang S, Younus O, Rawat D, Naik S, Giles E, Meadows N, Croft NM (2018) Clinical presentation and outcomes of diagnostic endoscopy in newly presenting children with gastrointestinal symptoms. J Pediatr Gastroenterol Nutr 66(6):876–881. http://journals.lww.com/00005176-201806000-00008

33.

Volonaki E, Sebire NJ, Borrelli O, Lindley KJ, Elawad M, Thapar N, Shah N (2012) Gastrointestinal endoscopy and mucosal biopsy in the first year of life. J Pediatr Gastroenterol Nutr 55(1):62–65. http://journals.lww.com/00005176-201207000-00012

34.

Dahshan A, Rabah R (2000) Correlation of endoscopy and histology in the gastroesophageal mucosa in children. J Clin Gastroenterol 31(3):213–216. http://journals.lww.com/00004836-200010000-00005

35.

Kaur S, Rosen JM, Kriegermeier AA, Wechsler JB, Kagalwalla AF, Brown JB (2017) Utility of gastric and duodenal biopsies during follow-up endoscopy in children with eosinophilic esophagitis. J Pediatr Gastroenterol Nutr 65(4):399–403. http://journals.lww.com/00005176-201710000-00012

Title: Are biopsies always necessary in upper and lower gastrointestinal endoscopy in children? A retrospective 10-year analysis
Authors: Rodrigo Corsato Scomparin
Pedro Luiz Toledo De Arruda Lourencao
Giovana Tuccile Comes
Wilson Elias De Oliveira Junior
Marcos Curcio Angelini
Paulo Cezar Haddad de Amorim
Simone Antunes Terra
Maria Aparecida Marchesan Rodrigues
Erika Veruska Paiva Ortolan
Publication date: 01-04-2021
Publisher: Springer Berlin Heidelberg
Keywords: Endoscopy
Colonoscopy
Upper and Lower Gastrointestinal Endoscopy
Published in: European Journal of Pediatrics / Issue 4/2021
Print ISSN: 0340-6199
Electronic ISSN: 1432-1076
DOI: https://doi.org/10.1007/s00431-020-03838-7

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Are biopsies always necessary in upper and lower gastrointestinal endoscopy in children? A retrospective 10-year analysis

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