Franke Markus, Geiß Andrea, Greiner Peter, Wellner Ulrich, Richter-Schrag Hans-Jürgen, Bausch Dirk, Fischer Andreas
University Hospital Freiburg, Department of General and Digestive Surgery - University of Freiburg, Faculty of Medicine, Freiburg, Germany.
University Hospital Freiburg, Department of Pediatric and Adolescent Medicine - University of Freiburg, Faculty of Medicine, Freiburg, Germany.
Endosc Int Open. 2016 Sep;4(9):E1011-6. doi: 10.1055/s-0042-109264. Epub 2016 Aug 25.
Gastrointestinal bleeding in children and adolescents accounts for up to 20 % of referrals to gastroenterologists. Detailed management guidelines exist for gastrointestinal bleeding in adults, but they do not encompass children and adolescents. The aim of this study was to assess gastrointestinal bleeding in pediatric patients and to determine an investigative management algorithm accounting for the specifics of children and adolescents.
Pediatric patients with gastrointestinal bleeding admitted to our endoscopy unit from 2001 to 2009 (n = 154) were identified. Retrospective statistical and neural network analysis was used to assess outcome and to determine an investigative management algorithm.
The source of bleeding could be identified in 81 % (n = 124/154). Gastrointestinal bleeding was predominantly lower gastrointestinal bleeding (66 %, n = 101); upper gastrointestinal bleeding was much less common (14 %, n = 21). Hematochezia was observed in 94 % of the patients with lower gastrointestinal bleeding (n = 95 of 101). Hematemesis (67 %, n = 14 of 21) and melena (48 %, n = 10 of 21) were associated with upper gastrointestinal bleeding. The sensitivity and specificity of a neural network to predict lower gastrointestinal bleeding were 98 % and 63.6 %, respectively and to predict upper gastrointestinal bleeding were 75 % and 96 % respectively. The sensitivity and specifity of hematochezia alone to predict lower gastrointestinal bleeding were 94.2 % and 85.7 %, respectively. The sensitivity and specificity for hematemesis and melena to predict upper gastrointestinal bleeding were 82.6 % and 94 %, respectively. We then developed an investigative management algorithm based on the presence of hematochezia and hematemesis or melena.
Hematochezia should prompt colonoscopy and hematemesis or melena should prompt esophagogastroduodenoscopy. If no source of bleeding is found, additional procedures are often non-diagnostic.
儿童及青少年胃肠道出血占转诊至胃肠病学家患者的20%。成人胃肠道出血有详细的管理指南，但未涵盖儿童及青少年。本研究旨在评估儿科患者的胃肠道出血情况，并确定一种考虑儿童及青少年特点的调查管理算法。
确定了2001年至2009年入住我们内镜科的胃肠道出血儿科患者（n = 154）。采用回顾性统计和神经网络分析来评估结果并确定调查管理算法。
81%（n = 124/154）的患者出血源可被识别。胃肠道出血主要为下消化道出血（66%，n = 101）；上消化道出血则少见得多（14%，n = 21）。下消化道出血患者中94%（n = 101中的95例）出现便血。呕血（67%，n = 21中的14例）和黑便（48%，n = 21中的10例）与上消化道出血相关。神经网络预测下消化道出血的敏感性和特异性分别为98%和63.6%，预测上消化道出血的敏感性和特异性分别为75%和96%。仅便血预测下消化道出血的敏感性和特异性分别为94.2%和85.7%。呕血和黑便预测上消化道出血的敏感性和特异性分别为82.6%和94%。然后我们基于便血、呕血或黑便的存在制定了一种调查管理算法。
便血应促使进行结肠镜检查，呕血或黑便应促使进行食管胃十二指肠镜检查。如果未发现出血源，额外的检查通常无法确诊。
