Clinical indications and outcomes of pediatric gastrointestinal endoscopy in a resource-limited healthcare system: Findings from the first multicenter study.

Abstract

Objectives: The objective of this study was to provide the first multicenter evaluation of pediatric gastrointestinal endoscopy in Palestine, specifically characterizing clinical indications, sedation practices, diagnostic and histopathologic yield, and outcomes.

Methods: This study was conducted across multiple hospitals in the West Bank, Palestine, including patients ≤18 years who underwent gastrointestinal endoscopy between January 2019 and December 2023.

Results: A total of 245 pediatric endoscopic procedures were performed across participating centers (mean age 15.2 ± 2.9 years; 51.0% female). Of these, 149 were upper endoscopies and 96 were lower endoscopies. Abnormal findings were documented in 113 upper endoscopies (75.8%), most commonly gastritis, esophagitis, and duodenitis, and in 72 lower endoscopies (75.0%), including colitis, polyps, and terminal ileitis. Biopsies were submitted in 186 procedures (75.9%), with histopathological abnormalities confirmed in 127 cases (68.3% of biopsied specimens). The most frequent final diagnosis was gastritis (n = 68; 27.8%), including Helicobacter pylori-associated and nodular gastropathy, followed by esophagitis (n = 17; 6.9%), Crohn's disease (n = 10; 4.1%), and ulcerative colitis (n = 10; 4.1%). Patients who underwent lower endoscopy were significantly older (mean age 16.3 ± 1.8 years) compared with those undergoing upper endoscopy (14.6 ± 3.2 years) or combined procedures (15.6 ± 3.0 years; p < 0.001). The chief presenting complaint was diarrhea (n = 24; 9.8%) and inflammatory bowel disease symptoms (n = 10; 4.1%) when patients underwent lower endoscopy, whereas the chief presenting complaint was abdominal pain (n = 54; 22.0%) and nausea/vomiting (n = 16; 6.5%) when patients underwent upper endoscopy.

Conclusion: This multicenter study demonstrates that pediatric gastrointestinal endoscopy in Palestine yields a high diagnostic rate, with abnormal findings documented in approximately three-quarters of both upper and lower procedures. The findings primarily emphasize the importance of strengthening biopsy protocols and diagnostic pathways in resource-limited healthcare systems.