Decreased relative diagnostic yield of esophagogastroduodenoscopy in children with gastroparesis

Abstract

Background: Esophagogastroduodenoscopy (EGD) and gastric emptying scintigraphy (GES) are commonly performed in the evaluation of children with upper gastrointestinal symptoms. It has been presumed, but not clarified, that gastroparesis increases the likelihood of identifying abnormalities on EGD. We sought to determine whether the presence of gastroparesis influenced the diagnostic yield of EGD in children.

Methods: We conducted a retrospective chart review of children who underwent both an EGD and GES within 3 months of each other for evaluation of upper gastrointestinal symptoms (eg, abdominal pain). Clinical history (symptoms, comorbidities, medications, and surgical procedures), GES results, and EGD histology reports were captured.

Results: A total of 125 children (46% female) were included, of whom, 70 (56%) had gastroparesis. Thirty-three (26%) children had liquid meal GES (1.2 ± 1.1 y of age, mean ± SD) and 92 (64%) had solid meal GES (12.4 ± 3.6 y of age). There was an overall trend toward a decreased frequency of biopsy abnormalities in those with gastroparesis (P=0.09). Those with gastroparesis identified through liquid meal GES were less likely to have reflux esophagitis on biopsy (P=0.002). Those with gastroparesis identified on solid meal GES were less likely to have gastritis (P=0.04). Symptoms, comorbidities, or medications were not predictive of GES or EGD results.

Conclusions: Children with gastroparesis may be less likely to have biopsy abnormalities identified on EGD in comparison to those without gastroparesis. Further prospective, larger, and multicenter studies are needed to validate our findings.

Figure 1

Relative Frequency of Abnormal Histological Findings in Subjects with Normal Gastric Emptying vs Gastroparesis. GER = Gastroesophageal Reflux, EE = Eosinophilic Esophagitis, ED = Eosinophilic Duodenitis. (A) All GES studies: Gastritis was found more frequently on biopsy in children with normal gastric emptying than in those with delayed gastric emptying (* P < 0.05). Other histological findings did not differ between groups. (B) Liquid meal GES studies: Reflux esophagitis on biopsy was detected more frequently in children with normal gastric emptying (** P = 0.005). Other histological findings did not differ between groups. (C) Solid meal GES studies: Gastritis was found more frequently on biopsy in children with normal gastric emptying than in those with delayed gastric emptying (* P < 0.05). This likely accounts for the difference in gastritis frequency for the overall group (Figure A). Other histological findings did not differ between groups.

Figure 2

Impact of Study Order. EGD = Esophagogastroduodenoscopy, GES = Gastric Emptying Scintigraphy. (A) EGD performed prior to GES: Patients with abnormal EGD findings did not differ from those with normal EGD findings in regard to the frequency of subsequent GES findings (P=0.16). (B) GES performed prior to EGD: Patients with gastroparesis did not differ from those with normal gastric emptying in regard to the frequency of subsequent EGD abnormal findings (P=0.26).