The concordance of endoscopic and histologic findings of 1000 pediatric EGDs

BackgroundPediatric gastroenterologists frequently perform routine endoscopic biopsies despite normal-appearing mucosa during EGD. Older small studies have supported this practice.ObjectiveTo re-evaluate the concordance between endoscopic appearance and histology in the era of high-definition endoscopy.DesignRetrospective cohort study.SettingSingle tertiary care center.PatientsA total of 1000 pediatric patients undergoing initial EGD.Main Outcome MeasurementsEndoscopic and histologic findings.ResultsThe overall rate of an endoscopic finding was 34.7%, which was 40.4% of a histologic finding. Concordance between the presence of any endoscopic finding and any histologic finding in all locations was 69.9% (Cohen’s κ coefficient = 0.32). In the esophagus, the concordance between any endoscopic finding and any histologic finding was 82.6% (κ = 0.45). The stomach was 73.2% concordant (κ = 0.18), and the duodenum was 89.3% concordant (κ = 0.42). The κ coefficient decreased when comparing specific findings in each location; it was 0.34 in the esophagus, 0.17 in the stomach, and 0.34 in the duodenum. If biopsy specimens had only been obtained when the endoscopist identified abnormal mucosa, 48.5% of the pathologic findings would have been missed. In patients with histology consistent with eosinophilic esophagitis, 30.2% had normal-appearing mucosa. For celiac disease, 43% had normal-appearing mucosa. In the stomach, an abnormal endoscopic appearance was more likely to have normal histology.LimitationsThe single-center, retrospective nature and more endoscopists than pathologists.ConclusionsThese data support the routine collection of biopsy specimens in the duodenum, stomach, and esophagus during EGD in pediatric patients.