Impact of the Rome II Pediatric Criteria on the Appropriateness of the Upper and Lower Gastrointestinal Endoscopy in Children
Résumé
Background: The demand for pediatric GI endoscopy has increased, resulting in a significant rise in overall costs. Aim: to assess the clinical impact of the Rome II criteria for FGIDs in selecting pediatric patients who underwent GI endoscopy. Methods: Indications and findings of GI endoscopic procedures performed before and after the publication of the Rome II criteria were retrospectively evaluated. Results: Upper GI endoscopy was performed in 1124 children, whereas 500 subjects underwent colonoscopy. Six-hundred-seven (54%) EGDs were positive, and 517 (46%) were negative, whereas 306 (61.1%) colonoscopies were positive, and 194 (38.9%) were negative. Of the 1624 procedures, 26% were considered inappropriate according to the Rome II criteria. Inappropriate procedures decreased significantly after publication of the Rome II criteria (OR, 3.7; 95% CI, 1.8-7.5). Of 1202 appropriate GI endoscopies, 502 EGD (62.7%) were significantly contributive, compared with only 105 (32.5%) of the 323 inappropriate procedures (OR, 3.5; 95% CI, 2.6-4.6;), whereas 265 (65.8%) colonoscopies were significantly contributive, compared with only 41 (42.3%) of the 97 inappropriate procedures (OR, 2.6; 95% CI, 1.6-4.1). Conclusions: The use of the criteria for FGIDs makes a significant positive impact in reducing unnecessary pediatric GI endoscopy.
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