Paediatric endoscopy performed by adult-service gastroenterologists.
BACKGROUND
Children often travel from district hospitals to teaching centres for endoscopic procedures by paediatric gastroenterologists. A 10-year district hospital experience of 'adult-service' gastroenterologists endoscoping children is reported with the aim of quantifying the workload, indications, sedation/anaesthesia practices, findings and safety of paediatric endoscopy performed by adult-service gastroenterologists.


METHODS
Data on endoscopic procedures in patients younger than 16 years of age between 1997 and 2006 were obtained from hospital case-notes and computerized endoscopy/histology databases and were analysed.


RESULTS
A total of 174 procedures (118 gastroscopies, 41 colonoscopies and 15 flexible sigmoidoscopies) were performed in 162 children. The median (interquartile range) age was 11.5 (5-14) years. Sixty-nine percent of patients were referred by paediatricians and 31% by general practitioners /other adult specialties. Children referred as outpatients waited a total of 50 (23.5-95) days from referral to procedure. Inpatient children waited 3 (1-4) days for their procedure. General anaesthesia was used in 89% (63 of 71) endoscopic procedures in children aged below 11 years and 100% of 47 procedures in children aged below 6 years. In contrast, 96% (99 of 103) procedures in children aged 11 years or older were done in the endoscopy unit with intravenous or no sedation. Organic disease was identified from 90 (52%) procedures. The most common diagnoses were coeliac disease (41), inflammatory bowel disease (26), gastro-oesophageal reflux (six) and foreign body removal (seven). No endoscopic complications occurred.


CONCLUSIONS
General gastroenterologists supported by paediatricians can provide endoscopic services for children safely and promptly in their local hospital. This is appropriate for the management of common gastrointestinal problems affecting children.
Hayat
Jamal O
JO
Gastroenterology Department, Wycombe Hospital, High Wycombe, Buckinghamshire HP11 2TT, UK.
Sirohi
Rohit
R
Gorard
David A
DA
D000293:Adolescent; D017677:Age Distribution; D000768:Anesthesia, General / Q000706:statistics & numerical data; D002648:Child; D002662:Child Health Services / Q000458:organization & administration / Q000592:standards*; D002675:Child, Preschool; D002983:Clinical Competence; D016292:Procedural Sedation / Q000379:methods; D016099:Endoscopy, Gastrointestinal / Q000592:standards* / Q000706:statistics & numerical data; D004739:England; D005767:Gastrointestinal Diseases / Q000175:diagnosis*; D006302:Health Services Research / Q000379:methods; D006767:Hospitals, District / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D012017:Referral and Consultation; D012189:Retrospective Studies; D016526:Workload / Q000706:statistics & numerical data