Risks of endoscopy in hospitalized pediatric patients with collagen vascular diseases

Background: The gastrointestinal manifestations of the collagen vascular di seases have been well described in the pediatric population. These patients frequently have symptoms that constitute indications for endoscopy. Howeve r, the risks and benefits of endoscopy in this population have not been exa mined. Methods: A retrospective review of all patients with collagen vascular dise ases hospitalized during a 7-year period was undertaken, and those patients who underwent endoscopy were identified. Results: Nine patients (5%) underwent endoscopic procedures (eight upper an d three lower endoscopy). Complications and outcomes were analyzed. Indicat ions for endoscopy included abdominal pain, gastrointestinal (GI) bleeding, and/or vomiting and diarrhea. Two patients had complications that required surgery within 1 day of the endoscopic procedure. One of these patients su bsequently died with GI bleeding. Five of the nine patients had changes in their management after endoscopy. Helicobacter pylori infection was identif ied and treated in two patients. Three patients had esophagitis or gastriti s and acid suppression treatment was started or optimized. Vasculopathy was present in the patients who had complications. Conclusions: This series suggests that endoscopy can provide useful informa tion for the management of the pediatric patient with GI symptoms and colla gen vascular diseases. However, because serious and potentially life-threat ening complications can occur, great care is needed in evaluating the risk/ benefit ratio of endoscopy in these patients.