Performance of ESPGHAN/ESGE guideline-concordant pediatric upper gastrointestinal endoscopy: histopathologic yield and clinical predictors

Aims: This study aimed to evaluate concordance with the 2017 joint the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the European Society of Gastrointestinal Endoscopy (ESGE) guideline for pediatric gastrointestinal (GI) endoscopy, histopathologic yield, and associated clinical factors among children undergoing stand-alone diagnostic upper GI endoscopy, after excluding procedures performed through predetermined diagnostic pathways independent of presenting symptoms. Methods: Patients aged 0–18 years who underwent upper GI endoscopy at the Pediatric Gastroenterology Clinic of Şanlıurfa Training and Research Hospital between October 2022 and July 2024 were retrospectively evaluated. After excluding subsequent repeat or follow-up procedures, procedures performed with simultaneous colonoscopy, procedures without biopsy, patients with anti-tissue transglutaminase (anti-tTG) IgA levels greater than three times the upper limit of normal (ULN), and cases with incomplete data, 407 patients undergoing stand-alone diagnostic upper GI endoscopy were included. Indications were classified by guideline concordance. Independent predictors of histopathological positivity were assessed using two conceptually separate multivariable logistic regression models: a guideline-based model and a clinical model. Diagnostic performance of guideline concordance and endoscopic findings was evaluated via sensitivity and specificity analyses. Results: The rate of reported abnormal endoscopic findings was 91.6%, whereas the histopathological diagnostic yield was 65.8% and 64.9% of procedures were guideline-concordant. In the guideline-association model, guideline concordance (adjusted odds ratio [aOR], 5.56; 95% CI, 3.46–8.91) and age >12 years (aOR, 2.12; 95% CI, 1.31–3.42) were independently associated with histopathological positivity. In the clinical-factor model, alarm features (aOR, 7.07; 95% CI, 3.51–14.23) and age >12 years (aOR, 1.73; 95% CI, 1.08–2.78) were positively associated with histopathological positivity, whereas a gastroesophageal reflux disease-related indication was negatively associated with it (aOR, 0.38; 95% CI, 0.22–0.66). Guideline concordance showed high sensitivity (76.9%) but limited specificity (58.3%); endoscopic findings showed high sensitivity (98.5%) but low specificity (21.6%) for histopathological positivity. Conclusion: In this selected population of children undergoing stand-alone diagnostic upper GI endoscopy, concordance with the 2017 ESPGHAN/ESGE guideline was associated with a higher likelihood of a positive diagnostic histopathological finding but was insufficient as the sole basis for patient selection. Guideline recommendations should therefore be considered alongside clinical risk markers such as age and alarm symptoms. Histopathological assessment may provide additional diagnostic information beyond macroscopic endoscopic appearance, although its effect on subsequent clinical management was not evaluated.