Way Seah Lee, Christopher CM Boey, Pei Fan Chai, Department of Paediatrics, University Malaya Medical Centre, 50603 Kuala Lumpur, Malaysia.
World J Gastroenterol. 2013 Dec 21;19(47):9077-83. doi: 10.3748/wjg.v19.i47.9077.
To determine the predictability of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) and American Society for Gastrointestinal Endoscopy (ASGE) guideline with regard to appropriate endoscopic practice in children, positive endoscopic findings and contributive yield in clinical practice.
This was a descriptive, retrospective analysis, conducted at the Department of Paediatrics, University Malaya Medical Centre, Malaysia. All children who had esophagogastroduodenoscopy (EGD) and colonoscopy from January 2008 to June 2011 were included. An endoscopy was considered appropriate when its indication complied with the NASPGHAN and ASGE guideline. All endoscopic findings were classified as either positive (presence of any endoscopic or histologic abnormality) or negative (no or minor abnormality, normal histology); effecting a positive contributive (a change in therapeutic decisions or prognostic consequences) or non-contributive yield (no therapeutic or prognostic consequences).
Overall, 76% of the 345 procedures (231 EGD alone, 26 colonoscopy alone, 44 combined EGD and colonoscopy) performed in 301 children (median age 7.0 years, range 3 months to 18 years) had a positive endoscopic finding. Based on the NASPGHAN and ASGE guideline, 99.7% of the procedures performed were considered as appropriate. The only inappropriate procedure (0.3%) was in a child who had EGD for assessment of the healing of gastric ulcer following therapy in the absence of any symptoms. The overall positive contributive yield for a change in diagnosis and/or management was 44%. The presence of a positive endoscopic finding was more likely to effect a change in the therapeutic plan than an alteration of the initial diagnosis. A total of 20 (5.8%) adverse events were noted, most were minor and none was fatal.
The NASPGHAN and ASGE guideline is more likely to predict a positive endoscopic finding but is less sensitive to effect a change in the initial clinical diagnosis or the subsequent therapeutic plan.
确定北美儿科学会胃肠病学、肝病学和营养学分会（NASPGHAN）和美国胃肠内镜学会（ASGE）指南在儿童内镜实践中的预测性，以及该指南在阳性内镜发现和临床实践中的有价值程度。
本研究为回顾性描述性研究，在马来西亚马来亚大学医学中心儿科进行。纳入 2008 年 1 月至 2011 年 6 月期间行食管胃十二指肠镜（EGD）和结肠镜检查的所有患儿。符合 NASPGHAN 和 ASGE 指南适应证的内镜检查被认为是恰当的。所有内镜发现分为阳性（存在任何内镜或组织学异常）或阴性（无或轻微异常，组织学正常）；有阳性（改变治疗决策或预后）或无阳性（无治疗或预后影响）价值。
301 例患儿（中位年龄 7.0 岁，范围 3 个月至 18 岁）共行 345 次内镜检查（231 次单独行 EGD，26 次单独行结肠镜检查，44 次同时行 EGD 和结肠镜检查），其中 76%的内镜检查有阳性发现。根据 NASPGHAN 和 ASGE 指南，99.7%的内镜检查被认为是恰当的。唯一不恰当的检查（0.3%）是在没有任何症状的情况下，为评估治疗后胃溃疡愈合情况而行 EGD。改变诊断和/或治疗的总体阳性有价值程度为 44%。阳性内镜发现更可能改变治疗计划，而不是改变初始诊断。共观察到 20 例（5.8%）不良事件，大多数为轻微事件，无死亡病例。
NASPGHAN 和 ASGE 指南更可能预测阳性内镜发现，但对改变初始临床诊断或后续治疗计划的敏感性较低。
