Diagnostic Yield, Clinical Predictors and Histopathologic Findings in Pediatric Colonoscopy

Objective: Pediatric colonoscopy is widely used for the evaluation of gastrointestinal symptoms, but its diagnostic yield varies according to clinical presentation. This study aimed to assess the endoscopic and histopathologic diagnostic yield of pediatric colonoscopy, identify clinical predictors of positive findings, and evaluate the additional value of biopsy in macroscopically normal findings. Methods: This retrospective single-center study included children aged ≤18 years who underwent colonoscopy at a tertiary pediatric gastroenterology unit. Among 250 colonoscopy records, 230 index colonoscopies were included in patient-level analyses. A specific histopathologic diagnosis included Crohn disease, ulcerative colitis, eosinophilic colitis, infectious colitis, juvenile polyp, or adenomatous polyp. Multivariable logistic regression was used to identify independent predictors of abnormal endoscopic findings and specific histopathology. Results: The mean age was 12.0 ± 4.7 years, and 52.2% of patients were female. Abnormal endoscopic findings were identified in 155/230 patients (67.4%). Biopsies were obtained in 201 patients, of whom 58 (28.9%) had a specific histopathologic diagnosis. Children with alarm features had higher endoscopic yield than those with isolated abdominal pain (73.8% vs. 45.8%; OR 3.33; p < 0.001) and higher specific histopathologic yield among biopsied patients (34.9% vs. 8.2%; OR 6.04; p < 0.001). Rectal bleeding independently predicted abnormal endoscopy (aOR 4.33, 95% CI 1.98–9.48; p < 0.001). Younger age (aOR 0.90 per year, 95% CI 0.84–0.97; p = 0.008), rectal bleeding (aOR 4.61, 95% CI 2.12–10.01; p < 0.001), and chronic diarrhea (aOR 2.37, 95% CI 1.15–4.85; p = 0.019) independently predicted specific histopathology. Only 1/62 patients (1.6%) with a macroscopically normal colonoscopy had a specific histopathologic diagnosis. Conclusions: Pediatric colonoscopy has substantially higher diagnostic yield in children with alarm features, particularly rectal bleeding and chronic diarrhea, whereas isolated abdominal pain is associated with low disease-specific histopathologic yield. Clinical presentation and age may help improve patient selection for colonoscopy.