title: The concordance of endoscopic and histologic findings of 1000 pediatric EGDs.
abstract: BACKGROUND
  Pediatric gastroenterologists frequently perform routine endoscopic biopsies despite normal-appearing mucosa during EGD. Older small studies have supported this practice.
  
  
  OBJECTIVE
  To re-evaluate the concordance between endoscopic appearance and histology in the era of high-definition endoscopy.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Single tertiary care center.
  
  
  METHODS
  A total of 1000 pediatric patients undergoing initial EGD.
  
  
  METHODS
  Endoscopic and histologic findings.
  
  
  RESULTS
  The 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.
  
  
  CONCLUSIONS
  The single-center, retrospective nature and more endoscopists than pathologists.
  
  
  CONCLUSIONS
  These data support the routine collection of biopsy specimens in the duodenum, stomach, and esophagus during EGD in pediatric patients.
authors.affiliation: Department of Pediatrics, Digestive Health Institute, University of Colorado Denver School of Medicine, Aurora, Colorado, USA.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Sheiko
authors.affiliation: Children's Outcomes Research Program, Children's Hospital Colorado, University of Colorado Denver School of Medicine, Aurora, Colorado, USA.
authors.forename: James A
authors.initials: JA
authors.lastname: Feinstein
authors.affiliation: Department of Pathology, University of Colorado Denver School of Medicine, Aurora, Colorado, USA.
authors.forename: Kelley E
authors.initials: KE
authors.lastname: Capocelli
authors.affiliation: Department of Pediatrics, University of Colorado Denver School of Medicine, Aurora, Colorado, USA.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Kramer
mesh_terms: D000293:Adolescent; D001706:Biopsy / Q000379:methods; D002446:Celiac Disease / Q000175:diagnosis / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004386:Duodenum / Q000473:pathology*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D057765:Eosinophilic Esophagitis / Q000175:diagnosis / Q000473:pathology; D004947:Esophagus / Q000473:pathology*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009092:Mucous Membrane / Q000473:pathology*; D012189:Retrospective Studies; D013270:Stomach / Q000473:pathology*; D013272:Stomach Diseases / Q000175:diagnosis / Q000473:pathology