P Bose et al. JPGN 2022; 75: 514-520. Endoscopy in Infants With Gastrointestinal Bleeding Has Limited Diagnostic or Therapeutic Benefit
I read this article shortly after convincing a surgical colleague to explore a well-appearing 6 month old with gastrointestinal bleeding for a Meckel’s diverticulum rather than undergo endoscopy.
In this retrospective cohort study of hospitalized infants (n=56, =/< 12 months) with gastrointestinal bleeding, the authors reviewed endoscopic procedures (EGD, Colonoscopy, Flexible Sigmoidoscopy) with respect to identifying diagnosis and in terms of outcomes.
- Seven endoscopies identified sources of GIB: gastric ulcers, a duodenal ulcer, gastric angiodysplasia, esophageal varices, and an anastomotic ulcer.
- Intervention for bleeding control occurred in just 3 cases (5.4%); two of these had liver disease.
- Most (55%) had no abnormalities on endoscopy
- The authors detail two fatal cases in which GIB started in the first week of life. Both had complications occurring within 3 hours of endoscopy, one with a gastric perforation and one with necrotizing enterocolitis.
My take: Endoscopy in infants with GIB is rarely beneficial. Supportive care and surgical interventions should be considered, especially in those without underlying liver disease.
Related blog posts:
- Timing of Upper Endoscopy with GI Bleeding -Is It Safer to Wait a Bit? | gutsandgrowth
- ACG Guideline: Upper Gastrointestinal and Ulcer Bleeding | gutsandgrowth
- Amazing Case Report: Speedy Recognition of an Aortoesophageal Fistula | gutsandgrowth
- Cutting Edge for Endoscopic Control of Bleeding | gutsandgrowth
- GI Bleeding -Forrest Classification
- All Bleeding Stops (part 2)
- All bleeding stops | gutsandgrowth
- Superior Results for Over-The Scope Clip for Severe UGI Bleeding
- Hemospray Efficacy and Rebleeding
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