The Portland Hospital for Women and Children, London, UK.
Department of Public Health Sciences, University of Turin, Turin.
J Pediatr Gastroenterol Nutr. 2019 Jul;69(1):6-12. doi: 10.1097/MPG.0000000000002326.
To critically appraise ileocolonoscopy (IC) practice in a large tertiary center, where IC is exclusively performed by experienced pediatric colonoscopists, particularly focusing on indications for the procedure; bowel preparation efficacy; IC completion rates and timings; diagnostic yield; and complications.
We prospectively evaluated all patients referred to our clinic between July 2015 and June 2016. Data on age, height and weight, sex, surgical history, indications for colonoscopy, bowel preparation given, and bowel cleansing efficacy were collected. The following were calculated: percentage of terminal ileal (TI) intubation; time to terminal ileum; total duration of each procedure. In addition, we evaluated the number and the type of complications encountered and the number of patients readmitted within 30 days from the elective procedure. Endoscopic diagnostic yield, stratified for indication, was calculated.
A total of 1392 patients were referred; 181 required an endoscopic evaluation of the lower gastrointestinal (GI) tract (Outpatient Department conversion rate: 13%). Main indications for IC were: recurrent abdominal pain 38.1%; unexplained chronic diarrhea 16%; suspected inflammatory bowel disease (IBD) 24.9%; isolated rectal bleeding 13.2%; occult GI bleeding 1.6%; unexplained faltering growth 1.6%; IBD restaging 2.6%; and miscellaneous 1.6%. Terminal ileum was reached in all the patients (TI intubation rate = 100%). Median time to TI was 9.8 minutes (1-50 minutes). Time to TI was lower in younger patients compared to older ones (P = 0.005). Bowel cleansing was judged as grade 1 in 49.2%; grade 2 in 33.7%; grade 3 in 13.3%; and grade 4 in 3.9%. A significant statistical correlation was recorded between bowel cleansing and time to TI. The positive diagnostic yield was: 11.6% in patients with abdominal pain; 37.9% in patients with chronic diarrhea; 51.1% in patients with suspected IBD; 29.2% in patients with isolated rectal bleeding; 33.3% in patients with occult GI bleeding; 0% in patients with faltering growth; and 33% in the miscellaneous group.
In conclusion, appropriately targeted IC in the management of children with GI symptoms is a safe, fast, and useful investigation. TI intubation rates of 100% are achievable and desirable and can be conducted quickly. Poor bowel preparation impacts negatively on this and IC duration may be faster in younger children. High diagnostic yields have been recorded in patients with a clinical suspicion of IBD. Diagnostic yield in isolated recurrent abdominal pain is low. Training to excellence in pediatric IC should be a persistent goal.
批判性地评估在一家大型三级中心进行的回结肠内镜检查（IC）实践，该中心仅由经验丰富的儿科结肠镜检查医生进行 IC，特别关注该手术的适应证；肠道准备效果；IC 完成率和时间；诊断产量；以及并发症。
我们前瞻性评估了 2015 年 7 月至 2016 年 6 月期间我们诊所转介的所有患者。收集了年龄、身高和体重、性别、手术史、结肠镜检查适应证、给予的肠道准备情况以及肠道清洁效果的数据。计算了以下内容：回肠末端（TI）插管的百分比；到达回肠末端的时间；每个程序的总持续时间。此外，我们评估了遇到的并发症数量和类型，以及从择期手术起 30 天内再入院的患者数量。按适应证分层计算内镜诊断产量。
共转介了 1392 例患者；181 例需要进行下胃肠道（GI）内镜评估（门诊转介率：13%）。IC 的主要适应证为：复发性腹痛 38.1%；不明原因慢性腹泻 16%；疑似炎症性肠病（IBD）24.9%；孤立性直肠出血 13.2%；隐匿性胃肠道出血 1.6%；不明原因生长迟缓 1.6%；IBD 分期 2.6%；以及其他 1.6%。所有患者均到达回肠末端（TI 插管率为 100%）。到达回肠末端的中位数时间为 9.8 分钟（1-50 分钟）。与年龄较大的患者相比，年轻患者到达回肠末端的时间更短（P=0.005）。肠道清洁程度被评为 1 级的占 49.2%；2 级占 33.7%；3 级占 13.3%；4 级占 3.9%。肠道清洁程度与到达回肠末端的时间呈显著统计学相关性。阳性诊断产量为：腹痛患者为 11.6%；慢性腹泻患者为 37.9%；疑似 IBD 患者为 51.1%；孤立性直肠出血患者为 29.2%；隐匿性胃肠道出血患者为 33.3%；生长迟缓患者为 0%；以及其他组为 33%。
总之，针对有胃肠道症状的儿童进行适当的靶向 IC 是一种安全、快速且有用的检查。100%的 TI 插管率是可以实现和理想的，并且可以快速进行。肠道准备不佳会对此产生负面影响，而在年幼的儿童中，IC 持续时间可能会更快。在疑似 IBD 的患者中记录了较高的诊断产量。孤立性复发性腹痛的诊断产量较低。在儿科 IC 方面追求卓越的培训应该是一个持续的目标。
