Matching of endoscopic and histologic semiotics in 500 colonoscopies in children

Abstract

BACKGROUND: For the past 40 years, it has been a common practice to perform “routine” biopsies during any colonoscopy in children. Proponents of the “routine” approach to biopsies argue that there is a risk of missing such pathologies as collagenous and lymphocytic colitis; opponents say about the low incidence of such pathologies, especially in children, which makes the strategy of routine biopsy ineffective.

AIM: To identify the level of matching between endoscopic and histologic findings in colonoscopies in children. The secondary aim — 1 to identify predictors that impact the matching level between endoscopy and histology, as well as predictors which are highly informative on the consequent histologic changes.

METHODS: A retrospective analysis of findings of colonoscopies in patients, aged 0–18, was made. Descriptive statistics and binary logistic regression were used to determine the level of matching and potential predictors of matching with abnormal histology.

RESULTS: 500 colonoscopies were analyzed. Endoscopists revealed pathological changes in 92 (19.8%) patients, and histologists in 89 (17.8%). If to take histology as “the gold standard”, specificity of colonoscopy was 90.5%, sensitivity — 66.3%, accuracy — 86.2%, positive and negative predictive value — 87.5% and 72.5%. Endoscopic verification of the normal mucous was highly associated with the matching level [odds ratio (OR) 22.494, p <0.001]. The established diagnosis of inflammatory bowel disease (OR 3.598, p <0.001) and blood in stool (OR 2.557, p=0.022) were strong predictors of pathological findings at histologic examination. Other factors (abdominal pain, weight loss, developmental delay, diarrhea, juvenile rheumatoid arthritis, endoscope model and endoscopist’s experience) did not have a statistically significant impact at the matching level and we’re not predictors of pathological findings at histology (p >0.05).

CONCLUSION: Our data have demonstrated a good matching level between endoscopic and histologic findings, especially in case of the normal colon mucous. Predictors of abnormal histology were also identified: inflammatory bowel disease and blood in stool. At the same time, abdominal pain, weight loss, diarrhea and juvenile rheumatoid arthritis in combination with normal colon mucous at the endoscopic examination were not associated with abnormal histology. Future multicenter researches are needed to obtain the evidence base for the strategy of selective biopsies during colonoscopy in children.

Keywords

colonoscopy / histology / matching / biopsy / children

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Shavrov A.A., Ibragimov S.I., Shavrov A.A., Morozov D.A., Tertychnyy A.S., Kharitonova A.Y.