Sheiko Melissa A, Feinstein James A, Capocelli Kelley E, Kramer Robert E
Department of Pediatrics, Digestive Health Institute, University of Colorado Denver School of Medicine, Aurora, Colorado, USA.
Children's Outcomes Research Program, Children's Hospital Colorado, University of Colorado Denver School of Medicine, Aurora, Colorado, USA.
Gastrointest Endosc. 2015;81(6):1385-91. doi: 10.1016/j.gie.2014.09.010. Epub 2014 Nov 1.
Pediatric gastroenterologists frequently perform routine endoscopic biopsies despite normal-appearing mucosa during EGD. Older small studies have supported this practice.
To re-evaluate the concordance between endoscopic appearance and histology in the era of high-definition endoscopy.
Retrospective cohort study.
Single tertiary care center.
A total of 1000 pediatric patients undergoing initial EGD.
Endoscopic and histologic findings.
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.
The single-center, retrospective nature and more endoscopists than pathologists.
These data support the routine collection of biopsy specimens in the duodenum, stomach, and esophagus during EGD in pediatric patients.
儿科胃肠病学家在进行上消化道内镜检查（EGD）时，即便黏膜外观正常，也经常进行常规内镜活检。以往的小型研究支持这种做法。
在高清内镜时代重新评估内镜表现与组织学之间的一致性。
回顾性队列研究。
单一的三级医疗中心。
总共1000例接受初次EGD的儿科患者。
内镜和组织学检查结果。
内镜检查发现的总体发生率为34.7%，为组织学检查发现率的40.4%。所有部位任何内镜检查发现与任何组织学检查发现之间的一致性为69.9%（科恩κ系数=0.32）。在食管，任何内镜检查发现与任何组织学检查发现之间的一致性为82.6%（κ=0.45）。胃的一致性为73.2%（κ=0.18），十二指肠为89.3%（κ=0.42）。在比较每个部位的具体发现时，κ系数降低；食管为0.34，胃为0.17，十二指肠为0.34。如果仅在内镜医师识别出异常黏膜时获取活检标本，则会遗漏48.5%的病理发现。在组织学符合嗜酸性食管炎的患者中，30.2%的患者黏膜外观正常。对于乳糜泻，43%的患者黏膜外观正常。在胃中，异常的内镜表现更有可能组织学正常。
单中心、回顾性研究性质以及内镜医师多于病理医师。
这些数据支持在儿科患者进行EGD时常规采集十二指肠、胃和食管的活检标本。
