Paediatric Gastrointestinal Endoscopy Clinical Outcomes

Upper Gastrointestinal (GI) endoscopy and ileocolonoscopy are important procedures for the diagnosis and management of paediatric gastrointestinal problems in children.

The Paediatric Gastroenterology, Hepatology and Nutrition Service at KKH performs the largest number of paediatric endoscopies in Singapore. Our department performs approximately 250 upper GI endoscopies and 150 colonoscopies annually, for both diagnostic and therapeutic purposes. Wireless video capsule endoscopies (VCE) are also offered for small bowel investigation. Therapeutic procedures performed include polypectomy, emergency GI bleed haemostatic therapy, foreign bodies retrieval, endoscopic therapy for oesophageal strictures.

The number of procedures performed in our department is increasing on a year-to-year basis due to the increased number of patients seen in our outpatient specialty clinics and inpatient services. We also have referrals for international patients. Our patients range from less than 6 months old to 20 years old.

Average annual procedures numbers (from 2018 to 2022):

The procedures take place in the operating theatre with a senior paediatric anaesthetist giving deep sedation or general anaesthesia. We are one of the few endoscopy centres in South East Asia whereby a paediatric anaesthetist is present throughout the procedure to ensure adequate sedation and to manage any potential cardiovascular or respiratory complications.

We are consistently meeting the targets set for high-quality paediatric ileocolonoscopy: caecal intubation rate of ≥90% and terminal ileal intubation rate ≥85% ⁽¹⁾. For paediatric upper GI endoscopy, we are achieving a 100% completion rate (intubation of second part of the duodenum).

Targets for endoscopy:

Although generally considered a safe procedure, endoscopy carries risks of perforation, bleeding and infection. The rate of complications during upper GI endoscopy and colonoscopy in our department stand at 0% - 0.05% respectively. A review of the international literature quoted the incidence of perforation during endoscopy to be from 0.06% to 0.3% ⁽²⁾. Bleeding risk of OGD in children has been reported to be 0.3% ⁽³⁾. For colonoscopies, a 0.43% rate of bleeding has been reported ⁽⁴⁾. We have maintained an extremely low endoscopy complication rate comparable to international figures.

References:
(1) Walsh CM, Lightdale JR, Leibowitz IH, et al. Pediatric Endoscopy Quality Improvement Network Quality Standards and Indicators for Pediatric Endoscopists and Endoscopists in Training: A Joint NASPGHAN/ESPGHAN Guideline. J Pediatr Gastroenterol Nutr. 2022;74(S1 Suppl 1):S44
(2) Friedt M, Welsch S. An update on pediatric endoscopy. Eur J Med Res. 2013 Jul 25;18(1):24.
(3) Thakkar K, El-Serag HB, Mattek N, Gilger MA. Complications of pediatric EGD: a 4-year experience in PEDS-CORI. Gastrointest Endosc. 2007 Feb;65(2):213-21.(
4) Thakkar K, El-Serag HB, Mattek N, Gilger M. Complications of pediatric colonoscopy: a five-year multicenter experience. Clin Gastroenterol Hepatol. 2008 May;6(5):515-20.