RESULTS OF ESOPHAGEAL BIOPSIES PERFORMED DURING TRIPLE ENDOSCOPY IN THE PEDIATRIC-PATIENT

Background: Endoscopic examination (direct laryngoscopy and bronchosco py) is the method of choice for diagnosis of respiratory symptoms of u nknown cause in children. However, gastroesophageal reflux is being re cognized increasingly often as a cause of pediatric respiratory sympto ms and is difficult to diagnose on the basis of findings from direct l aryngoscopy and bronchoscopy. In cases in which gastroesophageal reflu x was included in the differential diagnosis, we additionally performe d esophagoscopy with esophageal mucosal biopsies. Objectives: To deter mine the feasibility, safety, and efficacy of routinely performing eso phageal biopsies during triple endoscopy in children. Methods: Twenty- four children ranging in age from 2 weeks to 10 years were referred fo r airway evaluation. Under general anesthesia, children underwent dire ct laryngoscopy and bronchoscopy and esophagoscopy with mucosal biopsy . Results: Esophageal mucosa biopsy specimens were quickly and safely obtained during endoscopic evaluation. There were no complications. Re flux esophagitis was present in 54% of biopsy specimens, as suggested by basal cell hyperplasia, papillary elongation, and/or inflammatory c ell infiltrates. Conclusion: Gastroesophageal reflux is often difficul t to diagnose in the pediatric population. When direct laryngoscopy an d bronchoscopy is performed during examination of the child with airwa y symptoms,, the addition of esophagoscopy with mucosal biopsies will safely and quickly provide data regarding the: potential contribution of gastroesophageal reflux.