Correlation of endoscopy and histology in the gastroesophageal mucosa in children - Are routine biopsies justified?

Guidelines for obtaining biopsies during endoscopy in children are needed. The endoscopic evaluation may be considered deficient on many occasions if not accompanied by a histopathologic evaluation. A retrospective review of our endoscopic records and biopsies was undertaken to determine the correla tion of the visualized endoscopic appearance and the histopathologic findin gs in the upper gastrointestinal (GI) tract in children. Over a 1-year peri od, 204 patients, all of whom had esophageal biopsies and 59 of whom had ga stric biopsies as well, were evaluated by an upper GI endoscopy. Endoscopic findings included erythema, granularity, abnormal vascular pattern, friabi lity, erosions, plaques, ulceration, and strictures. Histologic evaluation of biopsies was undertaken by one pathologist according to the presence of and type of cellular infiltrate and cellular morphologic abnormalities in t he mucosa and submucosa where available. In this study, the correlation of endoscopic appearance with histology was rather limited in both the esophag us and the gastric mucosa. Low specificity and sensitivity of endoscopy in both locations (41% and 81% for the esophagus; and 43% and 86% for the gast ric mucosa, respectively) illustrated the discrepancy. The overall accuracy of endoscopic evaluation in matching the histologic diagnosis was not more than two out of three (63.8%), No single endoscopic finding had a reliable correlation with histologic diagnosis but some had higher predictive value than others. Of the multiple indications for endoscopy in children, recurr ent abdominal pain had the least diagnostic yield. Endoscopic appearance co rrelates poorly with histologic diagnosis in the gastroesophageal mucosa in children. Regardless of the appearance of the mucosa, routine biopsy durin g upper GI endoscopy in children should be encouraged.