Upper Gastrointestinal endoscopy in the paediatric population has evolved during the last 30 years with an increasing number of diagnostic and therapeutic applications. However endoscopy is a major contributor to the environmental footprint of the NHS. This study aims to assess the indications, diagnostic yields, concordance between histopathological and endoscopic findings and accuracy of upper endoscopies in two quite different Paediatric Gastroenterology referral centres.

A multicentre retrospective analysis of hospital records of children who underwent their first upper endoscopy in 2022. Demographics, endoscopic details (e.g., indications, findings and any complications), and histopathological findings were collected. The relationship between endoscopic findings and histopathological abnormalities was reported.

The study included 100 patients (age, 1- 17 years) of which 51% were male. The median age of the children was 11 years (10 patients, 10%).

The most common primary indications for endoscopy were generalized abdominal pain 21%, followed by suspicion of inflammatory bowel disease 17%, and then gastro oesophageal reflux disease/dysphagia with each 10% prevalence for each. Normal upper endoscopy was reported in 70 cases in the two centres (70%), comprising 74% in centre A and 66% in centre B. Most of the normal endoscopies were performed in children with abdominal pain 21.4%. The highest rates of endoscopic abnormalities were found in patients with a suspicion of inflammatory bowel disease. Macroscopic findings at endoscopy showed 63.3% sensitivity and 82.8% specificity to predict histopathological abnormalities. Females had higher rates of abnormal histological abnormalities 56.6%.

There is an extremely high rate of normal upper GI endoscopy in these two centres. Abdominal pain in particular has a low diagnostic yield. Concordance between endoscopic and histopathological findings is high but far from perfect and normal endoscopic findings shouldn`t discourage the endoscopist from obtaining tissue biopsies. The carbon footprint of endoscopy services has scope to be reduced significantly and should be a priority in the next 10 years for Paediatric GI centres.