Prospective peer-review audit of paediatric upper gastrointestinal endoscopy.
OBJECTIVE
To describe the findings of paediatric upper gastrointestinal endoscopy (UGE) and to reduce the rate of normal findings in children undergoing diagnostic UGE.


METHODS
Upper gastrointestinal endoscopy were performed at a single tertiary referral children's hospital over a 3-year period by four endoscopists. Patients were subgrouped into diagnostic categories (recurrent abdominal pain syndrome (RAP), oesophagitis, coeliac disease and enteropathy/inflammatory bowel disease) and endoscopists recorded their clinical diagnosis as above before each procedure. Endoscopic and biopsy findings were compared with clinical diagnosis. After the first year of audit each endoscopist was appraised of their practice and strategies implemented to reduce the normal UGE. In years 2 and 3 all endoscopists were audited by their peers on a monthly basis.


RESULTS
A total of 1172 UGE were performed over a 3-year period. Ninety per cent were diagnostic procedures, of which 48% were normal, 16% identified oesophagitis, 11% coeliac disease, 6% gastritis, 3%Helicobacter pylori and 1% peptic ulcer disease. Peer-review audit significantly reduced the number of normal findings in coeliac disease, RAP and overall (P < 0.01) but not in the groups with presumed oesophagitis or investigation of enteropathy/inflammatory bowel disease.


CONCLUSIONS
A high proportion of patients undergoing UGE have normal procedures. Peer-review audit can reduce the number of normal procedures particularly in RAP and in the diagnosis of coeliac disease.
O'Loughlin
Edward V
EV
Department of Gastroenterology, The Children's Hospital at Westmead, Sydney, New South Wales, Australia. tedo@chw.edu.au
Dutt
Shoma
S
Kamath
Ramananda
R
Gaskin
Kevin
K
Dorney
Stuart
S
D000293:Adolescent; D002446:Celiac Disease / Q000000981:diagnostic imaging*; D002648:Child; D002675:Child, Preschool; D016099:Endoscopy, Gastrointestinal / Q000592:standards*; D004941:Esophagitis / Q000000981:diagnostic imaging*; D006801:Humans; D008485:Medical Audit; D009517:New South Wales; D010380:Peer Review; D011859:Radiography; D041742:Upper Gastrointestinal Tract / Q000000981:diagnostic imaging*