Why not colonoscopy? An audit of lower gastrointestinal endoscopy in children

Abstract

Introduction: Suspected inflammatory bowel disease (IBD) is the most common indication for pediatric colonoscopy. Current quality indicators for colonoscopy target colorectal cancer surveillance, which is imperative in adults but largely irrelevant in children. Ileal intubation and inspection of the right colon increases diagnostic yield, but the literature is unclear on whether this is consistently achievable in children. Our aims, therefore, were to review lower gastrointestinal endoscopy in children to examine the extent of procedure in total colonoscopy (TC) to determine the rate of ileal and caecal intubation and to compare outcomes to flexible sigmoidoscopy (FS) where colon examination is incomplete. Methods: We undertook a retrospective review of all lower gastrointestinal endoscopy performed in a tertiary pediatric center between 1 January and 31 December 2017. The operating room data management system was used to identify all patients undergoing TC and FS. Age, indication, extent of procedure, and positive findings were noted. Extent of colonoscopy, confirmation of extent, and reason for incomplete procedures were noted. Results: A total of 371 lower gastrointestinal endoscopies, 295 colonosco-pies, and 76 FSs were performed, 10% (30/295) in children aged <6 years. Patients having FS were significantly younger (median age, 5.08 years [range, 0.39-17.38] vs 12.47 years [range, 1.37-18.28]) and more likely to have colonic resection (13% vs 2%), compared with those having TC. Caecal intubation rate was 97% (284/295), and the ileal intubation rate was 89% (262/295) in those undergoing TC. Caecal intubation was not achieved in nine patients because of poor bowel preparation, small patient size, and looping. Extent of colonoscopy was confirmed in 97% of proce-dures. Positive findings were noted in 50% of TC (148/295) and 38% of FS (29/76) procedures. The most common positive findings were ileitis/colitis (84%, 124/148) and polyps (14%, 20/148). Of those with histological ileitis/colitis, 12% (15/124) had findings present only in the ileum, while 24 additional patients only had right-sided (caecum, ascending) colitis. In-complete TC would therefore fail to demonstrate positive findings in 31% (39/124) of our cohort. Conclusion: High rates of ileal and caecal intubation are achievable in pe-diatric colonoscopy. Incomplete colonoscopy would miss positive findings in 31% of patients with IBD. Caecal and ileal intubation should be quality indicators in pediatric colonoscopy.L6244310242018-10-23 <br />