Are We Overdoing Pediatric Lower Gastrointestinal Endoscopy?.

Introduction: Lower gastrointestinal endoscopy (LGIE)/colonoscopy is frequently performed for rectal bleeding, recurrent abdominal pain and the diagnosis of Inflammatory Bowel Disease (IBD). Although these are common indications, the yield for isolated rectal bleeding and recurrent abdominal pain in the otherwise well child has not been described. Methods: A retrospective analysis of patients who had had a LGIE/colonoscopy from January 2001 - December 2010 was performed. The following data were collected: demographic data, indication, distance reached, macroscopic findings, microscopic findings, diagnosis, additional procedures and complications. Results: There were a total of 999 colonoscopies. The colonoscopy was normal in 390/999 (39%). The commonest indication for colonoscopy was for a diagnosis of suspected IBD, 449/999 (45%). IBD was confirmed in 282/449 (63%) but colonoscopy was normal in 143/449 (32%) of suspected IBD. Colonoscopy was performed for rectal bleeding in 197/999 (20%) of whom 141/197 (72%) were normal. There were 46 (5%) colonoscopies performed for recurrent abdominal pain which were all normal. Our completion rate to the cecum and beyond was 521/999 (52%). Our perforation rate over the 10 years was 0.2%. Conclusions: Colonoscopy is a safe procedure in pediatrics, however thirty-nine percent of colonoscopies in this series were normal. Many of these could have been avoided by eliminating colonoscopy in patients with recurrent abdominal pain in the absence of other clinical features, conservative management with laxatives for those with fresh blood per rectum typical of anal fissures, and fecal calprotectin screening prior to endoscopy in patients with suspected IBD. (C) 2016 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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