Medical opinion on the right and wrong reasons to use endoscopes on children

This page is research from an investigation by Brian Deer for The Sunday Times of London and the UK's Channel 4 Television into a campaign linking the MMR children's vaccine with autism. | Go to part I: The Lancet scandal | Go to part II: The Wakefield factor

Among the biggest concerns raised by Brian Deer's investigation was a battery of invasive and hazardous investigations performed on vulnerable autistic children. Here is a position paper setting out the circumstances in which specialist medical opinion believes endoscopies on children are appropriate. This statement appears to contrast dramatically with practices adopted at the Royal Free hospital, where these investigations were performed on extraordinary numbers

Medical Position Paper

Indications for Pediatric Gastrointestinal Endoscopy: A Medical Position Statement of the North American Society for Pediatric Gastroenterology and Nutrition

Robert H Squires Jr and Richard B Colletti

Journal of Pediatric Gastroenterology and Nutrition; 23 (2) : 107-110, 1996

Extracted sections:

DIAGNOSTIC UPPER ENDOSCOPY WITH BIOPSY - GENERALLY INDICATED

After acute volume resuscitation has been initiated for gastrointestinal bleeding, endoscopy may be considered for active, persistent, or recurrent bleeding, for hemodynamically significant hemorrhage, or to distinguish between variceal and non-variceal bleeding; for dysphagia, odynophagia, persistent refusal to eat, or persistent chest pain; for upper abdominal pain and/or discomfort with signs or symptoms suggesting serious organic disease (eg for weight loss, anorexia, anemia), associated with significant morbidity (eg prolonged school absenteeism, hospitalization, limitation of usual activities), or from pain or discomfort which persists despite a course of therapy for suspected acid peptic disease; for persistent vomiting of unknown cause, when sampling of esophageal, gastric, duodenal, or jejunal tissue/fluid is indicated, for clarification of imaging studies of the upper gastrointestinal tract, known or suspected ingestion of caustic material, or unexplained iron deficiency anemia.

DIAGNOSTIC UPPER ENDOSCOPY - GENERALLY NOT INDICATED

Diagnostic upper endoscopy is generally not indicated for uncomplicated gastroesophageal reflux, uncomplicated functional abdominal pain, or X-ray findings of uncomplicated gastroesophageal reflux, congenital hypertropic pyloric stenosis, or isolated pylorospasm.

DIAGNOSTIC COLONOSCOPY AND BIOPSY - GENERALLY INDICATED

Diagnostic colonoscopy and biopsy are generally indicated for unexplained iron deficiency anemia, evaluation of unexplained gastrointestinal bleeding such as melena of unknown origin or hematochezia; for clinically significant diarrhea of unexplained origin, evaluation of inflammatory bowel disease, evaluation of an abnormality on radiographic imaging which is likely to be clinically significant (eg filling defect, stricture); for intraoperative identification of a lesion that is not apparent at surgery, evaluation of patients for sexually transmitted diseases or rectal trauma (sigmoidoscopy only), or to obtain ileal or colonic tissue for diagnosis.”

DIAGNOSTIC COLONOSCOPY - GENERALLY NOT INDICATED

Diagnostic colonoscopy is generally not indicated for acute self-limited diarrhea, GI bleeding with demonstrated upper GI source, chronic, stable irritable bowel syndrome or chronic nonspecific abdominal pain unassociated with significant morbidity; or for constipation and encopresis or inflammatory bowel disease responding to therapy.

[The position paper from which these sections were extracted was authorized by the Executive
Council of the North American Society for Pediatric Gastroenterology and Nutrition]