title: The role of endoscopy in pediatric gastrointestinal bleeding.
abstract: OBJECTIVE
  Gastrointestinal bleeding in children and adolescents accounts for up to 20 % of referrals to gastroenterologists. Detailed management guidelines exist for gastrointestinal bleeding in adults, but they do not encompass children and adolescents. The aim of this study was to assess gastrointestinal bleeding in pediatric patients and to determine an investigative management algorithm accounting for the specifics of children and adolescents.
  
  
  METHODS
  Pediatric patients with gastrointestinal bleeding admitted to our endoscopy unit from 2001 to 2009 (n = 154) were identified. Retrospective statistical and neural network analysis was used to assess outcome and to determine an investigative management algorithm.
  
  
  RESULTS
  The source of bleeding could be identified in 81 % (n = 124/154). Gastrointestinal bleeding was predominantly lower gastrointestinal bleeding (66 %, n = 101); upper gastrointestinal bleeding was much less common (14 %, n = 21). Hematochezia was observed in 94 % of the patients with lower gastrointestinal bleeding (n = 95 of 101). Hematemesis (67 %, n = 14 of 21) and melena (48 %, n = 10 of 21) were associated with upper gastrointestinal bleeding. The sensitivity and specificity of a neural network to predict lower gastrointestinal bleeding were 98 % and 63.6 %, respectively and to predict upper gastrointestinal bleeding were 75 % and 96 % respectively. The sensitivity and specifity of hematochezia alone to predict lower gastrointestinal bleeding were 94.2 % and 85.7 %, respectively. The sensitivity and specificity for hematemesis and melena to predict upper gastrointestinal bleeding were 82.6 % and 94 %, respectively. We then developed an investigative management algorithm based on the presence of hematochezia and hematemesis or melena.
  
  
  CONCLUSIONS
  Hematochezia should prompt colonoscopy and hematemesis or melena should prompt esophagogastroduodenoscopy. If no source of bleeding is found, additional procedures are often non-diagnostic.
authors.affiliation: University Hospital Freiburg, Department of General and Digestive Surgery - University of Freiburg, Faculty of Medicine, Freiburg, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Franke
authors.affiliation: University Hospital Freiburg, Department of General and Digestive Surgery - University of Freiburg, Faculty of Medicine, Freiburg, Germany.
authors.forename: Andrea
authors.initials: A
authors.lastname: Geiß
authors.affiliation: University Hospital Freiburg, Department of Pediatric and Adolescent Medicine - University of Freiburg, Faculty of Medicine, Freiburg, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Greiner
authors.affiliation: Department of Surgery, University Medical Center Schleswig-Holstein, Campus Luebeck, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Wellner
authors.affiliation: University Hospital Freiburg, Department of Medicine II - University of Freiburg, Faculty of Medicine, Freiburg, Germany.
authors.forename: Hans-Jürgen
authors.initials: HJ
authors.lastname: Richter-Schrag
authors.affiliation: Department of Surgery, University Medical Center Schleswig-Holstein, Campus Luebeck, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Bausch
authors.affiliation: University Hospital Freiburg, Department of Medicine II - University of Freiburg, Faculty of Medicine, Freiburg, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Fischer