From the Pediatric Gastroenterology Institute, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
J Pediatr Gastroenterol Nutr. 2023 Apr 1;76(4):489-493. doi: 10.1097/MPG.0000000000003710. Epub 2023 Jan 23.
Societies' guidelines suggest routine tissue sampling in all children undergoing esophagogastroduodenoscopy and ileocolonoscopy, even in the absence of visible endoscopy abnormalities. We aimed to determine the agreement between endoscopic and histopathological findings in pediatric endoscopy and to assess the yield of routine biopsies from all sites.
Since January 2019, our endoscopy institute protocol has included routine biopsies sampling from the esophagus, stomach, duodenum, ileum, and colon in all diagnostic procedures. Agreement between tests was done using the kappa coefficient ( κ ). The study included all endoscopies performed during 2019.
In total, 541 diagnostic endoscopies were done during the study period with 434 (80%) esophagogastroduodenoscopy and 107 (20%) were ileocolonoscopy. Compared to histology, endoscopic findings performance were: esophagus-sensitivity 33%, specificity 98%; stomach-sensitivity 60%, specificity 89%; duodenum-sensitivity 50%, specificity 97%; duodenal bulb-sensitivity 47%, specificity 89%; terminal ileum-sensitivity 82%, specificity 100%; colon-sensitivity 84%, specificity 96%. Assessment of concordance between endoscopic and histopathologic findings reveals an overall low level of agreement in esophagogastroduodenoscopy ( κ of 0.39, 0.51, 0.53, and 0.24 for the esophagus, stomach, duodenal second part, and bulb, respectively), and good agreement in ileocolonoscopy ( κ of 0.88 and 0.81 for the ileum and colon, respectively).
Endoscopy findings are highly specific for histologic pathology, whereas the absence of findings correlates poorly with histologic findings. Ileocolonoscopy shows better agreement than esophagogastroduodenoscopy. Our data support routine tissue sampling in pediatric endoscopy.
学会的指南建议对所有接受食管胃十二指肠镜和回结肠镜检查的儿童进行常规组织采样，即使没有可见的内镜异常。我们旨在确定儿科内镜检查中内镜和组织病理学检查结果之间的一致性，并评估所有部位常规活检的产量。
自 2019 年 1 月以来，我们的内镜研究所方案包括在所有诊断程序中从食管、胃、十二指肠、回肠和结肠常规进行活检采样。使用κ系数（κ）来评估测试之间的一致性。该研究包括在 2019 年进行的所有内镜检查。
在研究期间共进行了 541 例诊断性内镜检查，其中 434 例（80%）为食管胃十二指肠镜检查，107 例（20%）为回结肠镜检查。与组织学相比，内镜检查结果表现为：食管-敏感性 33%，特异性 98%；胃-敏感性 60%，特异性 89%；十二指肠-敏感性 50%，特异性 97%；十二指肠球部-敏感性 47%，特异性 89%；末端回肠-敏感性 82%，特异性 100%；结肠-敏感性 84%，特异性 96%。评估内镜和组织病理学检查结果之间的一致性显示，食管胃十二指肠镜检查的总体一致性水平较低（食管、胃、十二指肠第二部分和球部的κ值分别为 0.39、0.51、0.53 和 0.24），而回结肠镜检查的一致性较好（回肠和结肠的κ值分别为 0.88 和 0.81）。
内镜检查结果对组织病理学具有高度特异性，而无发现与组织学发现相关性较差。回结肠镜检查比食管胃十二指肠镜检查具有更好的一致性。我们的数据支持在儿科内镜检查中进行常规组织采样。
