Overestimation of endoscopy diagnostic significance as the reason for overdoing colonoscopies in children

Introduction. The annual number of endoscopic examinations in children has been steadily increasing in recent years against the background of stable morbidity rates. Endoscopy does not reveal any pathological changes in the colon in half of the examined children. This is due by the fact clinicians to pay little attention to optimizing the overall clinical load, substantiating indications, and financial costs associated with colonoscopy.
Aim: to determine the diagnostic significance of colonoscopy in the comprehensive examination of the colon in children.
Materials and methods. There were examined 500 children aged from birth to 18 years, underwent to colonoscopy with biopsy and histological examination of biopsies, and a retrospective analysis of 500 colonoscopies was performed. Statistical data processing with the SPSS 17.0 software package for Windows 10 (USA) was used to determine the indicators of norm and pathology.
Results. Pathological changes in the colon mucosa were detected in 89 (17.8%) patients. The most common indications for colonoscopy were abdominal pain (n = 356; 71.2%), juvenile rheumatoid arthritis (JRA) (n = 190; 38%), and chronic diarrhea (n = 155; 31.1%). Unchanged colon mucosa was observed in 78.3% of children with abdominal pain, 91% of JRA patients, 74.8% with chronic diarrhea, and in more than 70% of children with physical retardation and weight loss. The lowest rates of unchanged intestinal mucosa were observed in children with inflammatory bowel diseases (53.7%) and hemocolitis (59.4%).
Conclusion. In 82.2% of cases, colonoscopy in children revealed unchanged colon mucosa. This indicates to a significant number of endoscopic examinations could not be performed with a strict selection of JRA patients, recurrent abdominal pain and chronic diarrhea. In this regard, it is necessary to optimize the referral of sick children, standardize the assessment of children before endoscopic examination and identify patients in whom colonoscopy will be diagnostically effective.

children, endoscopy, colonoscopy, diagnosis, overfulfilling, optimization

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