Practices in Paediatric Gastrointestinal Endoscopy at Kenyatta National Hospital and Gertrudes Children's Hospital in Nairobi Kenya

Gastroenterology & Hepatology International Journal
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Practices in Paediatric Gastrointestinal Endoscopy at Kenyatta

National Hospital and Gertrude’s Children’s Hospital in Nairobi,
Kenya
Kefa O1*, Laving A2, Muiva J3, Ogutu E4, Aabaken L5 and Bhat P6
Research Article
1
Consultant Family Physician and Gastroenterologist, Bondo County Hospital, Kenya
Volume 7 Issue 1
2
Pediatric Gastroenterologist and Senior Lecturer, Department of Pediatrics and child Health,
Received Date: April 28, 2022
University of Nairobi, Kenya
Published Date: May 27, 2022
3
Consultant Pediatrician and Pediatric Gastroenterologist, Kenyatta National Hospital, Kenya
DOI: 10.23880/ghij-16000193
4
Professor of Medicine, Consultant Physician and Gastroenterologist, University of Nairobi,
Kenya
5
Professor of Medicine, Chief of GI Endoscopy, OUS-Rikshospitalet University Hospital, Norway
6
Senior Research Fellow and Gastroenterologist, ANU Medical school/ Gastroenterology and Hepatology unit, Canberra, Australia
*Corresponding author: Otieno Kefa, Gastroenterology ( WGO), Consultant Family Physician/ Gastroenterologist, Senior
Medical Specialist (DDMS), Bondo County Hospital, PO BOX: 3537-40100, Kenya, Email: [email protected]
Abstract
Background: Gastrointestinal (GI) diseases are common in children worldwide and pediatric GI endoscopy has become a
fundamental component of healthcare for infants and children. There is a wide range of diagnostic and therapeutic indications
for pediatric upper and lower GI endoscopy as well as new diagnostic and therapeutic interventions for the endoscopic findings
Objectives: To document the indications, endoscopic findings and therapeutic procedures in pediatric upper and lower
gastrointestinal endoscopy at the Kenyatta National Hospital (KNH) and Gertrude’s children’s hospital.
Design: Cross-sectional, consecutive entry study
Setting: Kenyatta National Hospital and Gertrude’s children’s hospital
Materials and Methods: This study was done over a period of 5 months involving participants of age 13 years and below who
underwent GI endoscopy at the endoscopy units of KNH and Gertrude’s children’s hospital. The subjects who met the eligibility
criteria were recruited by the Principal Investigator through consecutive sampling. Data was recorded in a data abstraction
form. Permission to undertake the study was obtained from the combined institutional Research and Ethics Committee (IREC)
of KNH and University of Nairobi as well as the Ethics Review Board of Gertrude’s Children Hospital.Data was anonymized
prior to analysis. Written informed consent for the study was obtained from the participants’ parents or guardians. The data
collected was coded and entered in MsAccess data base. Data cleaning was done and the data exported into SPSS version
23.0statistical software. All statistical tests were performed at 5% level of significance.
Results: Mean age of the children was 7.3 years (std=3.9). Males were 58 (52.7%). OGD involved 79.1% of the participants. In
KNH, the main indications for OGD (oesophagogastroduodenoscopy) were upper GI bleed and dysphagia while in Gertrude’s
hospital, they were abdominal pain and emesis. Hematochezia was the predominant indication for colonoscopy. More study
participants had normal than abnormal gross and histological findings. The commonest gastroscopic findings were gastritis
Practices in Paediatric Gastrointestinal Endoscopy at Kenyatta National Hospital and Gertrude’s Gastroenterol Hepatol Int J
Children’s Hospital in Nairobi, Kenya
2 Gastroenterology & Hepatology International Journal
and esophagitis. Hiatus hernia was detected in only 4.8% of the children. The commonest colonoscopic finding was colonic
polyps. 69(62.7%) patients had results of biopsies taken being present. The commonest positive findings in the colon and
rectum were chronic ulcerative colitis and juvenile polyps, respectively. The main therapeutic procedures done were banding
for oesophageal varices, FB removal and oesophageal dilatation.
Conclusions: The higher percentages of normal gross and histologic findings indicate more a functional than organic etiology
to the GI presentations. Hiatus hernia is relatively uncommon in our population. Juvenile polyps are more common than
ulcerative colitis as a cause of hematochezia in children.
Recommendations: Considerations for higher possibility of functional diagnoses should be made for patients with recurrent
abdominal pains and recurrent emesis. Emphasis should be made for parents/guardians of children who require biopsy that
histology forms a crucial part of management.
Keywords: Hematochezia; Dysphagia; Gastritis; Esophagitis; Oesophageal Varices
Abbreviations: GI: Gastrointestinal; GA: General ingestion, recurrent vomiting with unknown cause,
Anesthesia; ESGE: European Society of Gastrointestinal hematemesis, hematochezia, unexplained chronic diarrhea,
Endoscopy; ESPGHAN: European Society for Pediatric chronic gastroesophageal reflux disease (GERD), to exclude
Gastroenterology Hepatology and Nutrition; GERD: other diseases, or surveillance of Barrett’s esophagus [2].
Gastroesophageal Reflux Disease; IREC: Institutional The diagnostic indications of ileocolonoscopy in pediatric
Research and Ethics Committee patients according to ESGE and ESPGHAN are unexplained
anemia, unexplained chronic diarrhea, perianal lesions
Introduction (fistula, abscess), rectal blood loss, unexplained failure to
thrive, radiological suspicion of ileocolonic stenosis/stricture
Gastrointestinal (GI) diseases are common in children and polyposis syndromes. The therapeutic indications for
worldwide and GI endoscopy in the pediatric population ileocolonoscopy are polypectomy, dilation of ileocolonic
has evolved during the past few decades with an increasing stenosis, treatment of hemorrhagic lesions, foreign body
number of diagnostic and therapeutic applications. removal and reduction of sigmoid volvulus. This study was
Technological improvements in endoscope design and undertaken to document the indications for these procedures
endoscopic devices have contributed immensely to the in the two tertiary care hospitals.
evolution of pediatric endoscopy and improvement in the
skills that reflect on training. There has also been improved Materials and Methods
sedation and general anesthesia (GA) of children by trained
anesthetists [1]. There is a gap in pediatric gastroenterology in This cross-sectional study was done over a period of
Sub-Saharan Africa and the evolution of this field is expected 5 months involving participants of age 13 years and below
to bridge it for the management of gastroenterological who underwent GI endoscopy at the endoscopy units of KNH
disorders in this region. Unlike adult gastroenterology, and Gertrude’s children’s hospital. 176 (100 males and 76
pediatric gastroenterology practice in Africa is younger and females) patients were screened for the study. 110 (58 males
much less advanced in the scope and skill of services offered. and 52 females) patients who met the eligibility criteria were
Pediatric OGD and Colonoscopy have led to an increased recruited by the Principal Investigator through consecutive
recognition of GI disorders that are unique to children. The sampling and included in the study. Written informed
increase of disease rates from these pediatric GI procedures consent for the study was obtained from the participants’
is more a reflection of increasing rates of disease diagnosis parents or guardians. A standard questionnaire was run for
than a true rise of disease occurrence. each study subject and included biodata and relevant details.
According to the European Society of Gastrointestinal Ethical Approval

Endoscopy/ European Society for Pediatric Gastroenterology
Hepatology and Nutrition (ESGE/ESPGHAN), the diagnostic Permission to undertake the study was obtained from
indications for EGD are weight loss, failure to thrive, the combined institutional Research and Ethics Committee
unexplained anemia, abdominal pain with suspicion of (IREC) of KNH and University of Nairobi as well as the Ethics
an organic disease, dysphagia or odynophagia, caustic Review Board of Gertrude’s Children Hospital.
Kefa O, et al. Practices in Paediatric Gastrointestinal Endoscopy at Kenyatta National Hospital and Copyright© Kefa O, et al.
Gertrude’s Children’s Hospital in Nairobi, Kenya. Gastroenterol Hepatol Int J 2022, 7(1): 000193.
Statistical Analysis Results

Data was recorded in a data abstraction form. Data was 110 (58 males and 52 females) patients were included in
anonymized prior to analysis. The data collected was coded the study. The mean age of the children in years was 7.3 ± 3.9
and entered in Ms Access data base. Data cleaning was done years. Males were 58 (52.7%) while 52(47.3%) were females.
and the data exported into SPSS version 23.0statistical (Tables 1-7) In both KNH and Gertrude’s children’s hospital,
software. All statistical tests were performed at 5% level of OGD was performed more than Colonoscopy (79.1% versus
significance. 17.3 %) (Figures 1-4).
Hospital
Total (N=110) p-value
Getrude (N=55) KNH (N=55)
Age (years)
Mean ± SD 7.6± 3.9 7.0± 3.9 7.3± 3.9 0.4771
(Range) (1.0 - 13.0) 0.667 - 13.000 (0.667 - 13.000)
Sex
Male 31 (56.4%) 27 (49.1%) 58(52.7%) 0.4452
Female 24 (43.6%) 28 (50.9%) 52 (47.3%)
Table 1: Socio demographic characteristics overall and by hospital.
1
T-test2 Chi square test
Hospital Total (N=110)

Variable p value
Getrude (N=55) Freq (Col %) KNH (N=55) Freq (Col %) Freq (Col%)
Indication <0.0013
Recurrent abdominal pain 30 (54.5%) 8 (14.5%) 38 (34.5%)
Hematochezia 4 (7.3%) 12 (21.8%) 16 (14.5%)
Recurrent emesis 10 (18.2%) 4 (7.3%) 14 (12.7%)
UGIB 3 (5.5%) 11 (20.0%) 14 (12.7%)
Dysphagia 2 (3.6%) 9 (16.4%) 11 (10.0%)
FB ingestion 4 (7.3%) 5 (9.1%) 9(8.2%)
Others 1 (1.8%) 4 (7.3%) 5 (4.5%)
Chronic diarrhea 1 (1.8%) 2 (3.6%) 3 (2.7%)
Procedures done 0.0493
OGD 47 (85.5%) 40 (72.7%) 87 (79.1%)
Colonoscopy 5 (9.1%) 14 (25.5%) 19 (17.3%)
OGD and colonoscopy 3 (5.5%) 1 (1.8%) 4 (3.6%)
Material ingested 0.0233
N 4 12 16
Button battery 0 (0.0%) 7 (58.3%) 7 (43.8%)
Caustic ingestion 2 (50.0%) 5 (41.7%) 7 (43.8%)
Coins 2 (50.0%) 0 (0.0%) 2 (12.5%)
Table 2: Indications and Procedure by hospital.
3
Fishers’ exact test
All the participants who had ingested a material in the two facilities underwent an OGD
(UGIB-upper gastrointestinal tract bleeding; FB-foreign body; OGD-oesophagogastroduodenoscopy)
Figure 1: Indications for Oesophagogastroduodenoscopy (OGD) in Gertrude and KNH.
Figure 2: Indications for Colonoscopy in Gertrude and KNH.
Hospital Total
Variable p value
Gertrude (N=55) Freq (Col %) KNH (N=55) Freq (Col %) (N=110)
Gross findings in pharynx 1.0003
N 3 3 6
Erythema 3 (100.0%) 2 (66.7%) 5 (83.3%)
Mouth Ulcers 0 (0.0%) 1 (33.3%) 1 (16.7%)
Gross findings in oesophagus < 0.0013
N 50 41 91
Normal 26 (52.0%) 14 (34.1%) 40 (44.0%)
Esophagitis 21 (42.0%) 5 (12.2%) 26 (28.6%)
Varices 3 (6.0%) 10 (24.4%) 13 (14.3%)
Stricture 0 (0.0%) 10 (24.4%) 10 (11.0%)
Others 0 (0.0%) 2 (4.9%) 2 (2.2%)
Hiatus Hernia 1.0003
N 50 41 91
No 49 (0.0%) 40 (97.6%) 89 (95.2%)
Yes 1 (100.0%) 1 (2.4%) 2 (4.8%)
Gross findings in stomach 0.1493
N 50 41 91
Normal 22 (44.0%) 19 (46.3%) 41 (45.1%)
Erosive gastritis 16 (32.0%) 11 (26.8%) 27 (29.7%)
Superficial ulcers 8 (16.0%) 2 (4.9%) 10 (11.0%)
Portal hypertensive
3 (6.0%) 6 (14.6%) 9 (9.9%)
Varices 0 (0.0%) 2 (4.9%) 2 (2.2%)

Cobblestone appearance 1 (2.0%) 0 (0.0%) 1 (1.1%)
Fundal tumour 0 (0.0%) 1 (2.4%) 1 (1.1%)
Gross findings in duodenum 0.1633
N 50 41 91
Normal 43 (86.0%) 34 (82.9%) 77 (84.6%)
Erosions 4 (8.0%) 3 (7.3%) 7 (7.7%)
Hyperemia 3 (6.0%) 0 (0.0%) 3 (3.3%)
Ulceration 0 (0.0%) 2 (4.9%) 2 (2.2%)
Bile reflux 0 (0.0%) 1 (2.4%) 1 (1.1%)
Polyps 0 (0.0%) 1 (2.4%) 1 (1.1%)
0.0373
N 8 15 23
Normal 8 (100.0%) 6 (40.0%) 14 (60.8%)
Polyps 0 (0.0%) 6 (40.0%) 6 (26.1%)
Mucosal ulceration 0 (0.0%) 2 (13.3%) 2 (8.7%)
Erythema 0 (0.0%) 1 (6.7%) 1 (4.3%)
Gross findings in rectum 0.7573
N 9 14 23
Normal 7 (77.8%) 11 (78.6%) 18 (78.3%)
Polyp 2 (22.2%) 2 (14.3%) 4 (17.4%)
Ulcers 0 (0.0%) 1 (7.1%) 1 (4.3%)
Biopsy results < 0.0012
N 55 55 110
Absent 8 (14.5%) 33 (60.0%) 41 (37.3%)
Present 47 (85.5%) 22 (40.0%) 69 (62.7%)
Table 3: Gross findings by hospital.
Hospital
Variable Getrude (N=55) KNH (N=55) Total P-value
Freq (Col %) Freq (Col %)
Histological findings in esophagus < 0.0013
N 42 4 46
Normal 38 (90.5%) 0 (0.0%) 38 (82.6%)
Esophagitis 3 (7.1%) 3 (75.0%) 6 (13.0%)
Eosinophilic esophagitis 1 (2.4%) 0 (0.0%) 1 (2.2%)
Squamous cell carcinoma 0 (0.0%) 1 (25.0%) 1 (2.2%)
Histological findings in stomach < 0.0013
N 42 14 55
Normal 25 (61.0%) 0 (0.0%) 25 (45.5%)
Superficial gastritis 15 (36.6%) 13 (92.9%) 28 (50.9%)
Atrophic gastritis 0 (0.0%) 1 (7.1%) 1 (1.8%)
Erosions 1 (2.4%) 0 (0.0%) 1 (1.8%)
Histological findings in duodenum 0.0123
N 40 2 42
Normal 37 (92.5%) 0 (0.0%) 37 (88.1%)
Duodenitis 1 (2.5%) 2 (100.0%) 3 (7.1%)
Atrophic enteropathy 1 (2.5%) 0 (0.0%) 1 (2.4%)
Lymphoid hyperplasia 1 (2.5%) 0 (0.0%) 1 (2.4%)
Histological findings in colon 0.0213
N 5 8 13
Normal 4 (80.0%) 0 (0.0%) 4 (30.8%)
Chronic ulcerative colitis 1 (20.0%) 3 (37.5%) 4 (30.8%)
Juvenile polyp 0 (0.0%) 3 (37.5%) 3 (23.1%)
Lymphonodular hyperplasia 0 (0.0%) 2 (25.0%) 2 (15.4%)
Histological findings in rectum 0.4293
N 6 2 8
Normal 4 (66.7%) 0 (0.0%) 4 (50.0%)
Juvenile Polyp 2 (33.3%) 2 (100.0%) 4 (50.0%)
H. pylori status 0.4363
N 47 22 69
Positive 8 (17.1%) 6 (27.3%) 14 (20.3%)
Negative 39 (82.9%) 16 (72.7%) 55 (79.7%)
Table 4: Histological Findings by hospital.
Figure 3: OGD findings by hospital.
Figure 4: Colonoscopy findings by hospital.
Gertrude KNH Total

N 50 41 91
Banding 2 (4%) 9 (22%) 11 (12.1%)
Dilatation 0 (0%) 8 (19.5%) 8 (8.8%)
PEG tube insertion 1 (2%) 3 (7.3%) 4 (4.4%)
FB removal 2(4%) 7 (17.1%) 9 (9.9 %)
No procedure 45 (90%) 14 (33.3%) 59 (64.8 %)
Table 5: Therapeutic procedures in OGD.
Gertrude KNH Total

N 8 15 23
Polypectomy 1 (13.5%) 6 (40%) 7 (30.4%)
No procedure 7 (87.5%) 9 (60%) 16 (69.6)
Table 6: Therapeutic procedures in Colonoscopy.
Hospital
Variable Total (N=110) p value
Getrude (N=55) Freq (Col%) KNH (N=55) Freq (Col%)
Therapeutic procedure 0.2733
N 6 33 39
Banding varices 2 (33.3%) 9 (27.3%) 11 (28.2%)
Polypectomy 1 (16.7%) 6 (18.2%) 7 (18.0%)
Dilatation 0 (0.0%) 8 (24.2%) 8 (20.5%)
PEG tube insertion 1 (16.7%) 3 (9.1%) 4 (10.3%)
FB removal 2 (33.3%) 7 (21.2%) 9 (23.1%)
Table 7: Therapeutic procedures as proportions of Endoscopic interventions.
Discussion 7 (43.8%) children presenting with each. This is different

from what is observed in other studies with a Taiwan study
Sociodemographic Characteristics showing that most of the foreign bodies ingestion was coins
(56.8%), button batteries (21.6%), sharp objects (12.2%)
There was no statistically significant difference between then chicken bones (n = 2, 2.7%) [8]. In another study in
the mean ages of the children seen in the two facilities India, coins were the most frequent offending agents in
(p=0.477). There was also no significant difference between children (87.5%) [9]. The number of children by diagnoses
the two genders of the children in both facilities (p=0.445). of material ingestion seen at endoscopy (button battery,
The total number of males was 58 (52.7%) while the caustic ingestion and coins) stood at 16 as compared to the
remaining 52(47.3%) were females. This is comparable to a 9 children who came with FB ingestion as an indication for
5 year retrospective study in Ethiopia where 55.3% of the OGD. This observation demonstrates that in this study, the
study participants were male children [3]. There was no number of children with a FB in their upper digestive tract
significant difference in gender distribution between the two was more than the number who presented with FB ingestion
facilities. as an indication for OGD.
In both KNH and Gertrude’s children hospital, OGD were In KNH, hematochezia and chronic diarrhoea were the
performed more than Colonoscopy (79.1% versus 17.3 %). indications for colonoscopy at 12(85.7%) and 2(14.3%) of
This is in keeping with findings in other centers which offer the study participants, respectively. In Gertrude’s hospital,
GI endoscopy [4-7]. colonoscopy was done for hematochezia and chronic
diahhoea at 4(80%) and 2 (20%) of the study participants,
Indications respectively. These findings are comparable to findings of a
similar study in Sudan where the predominant indications
In KNH, the indications for OGD in decreasing order of
for colonoscopy were rectal bleeding (‎87%)‎, diarrhoea (‎19%)‎
occurrence were upper GI bleed (20.2 %), dysphagia (16.4%),
and anaemia (‎10%) [7]. In our study, only 1 out of 14 children
recurrent abdominal pain (14.5%), foreign body ingestion
(7.1%) and 3 out of 8 children (37.5%) had colonoscopy for
(9.1 %), recurrent emesis (7.3%) and others (convulsive
recurrent abdominal pain in KNH and Gertrude’s children
disorder, hypoxic brain Injury, small for age and failure to
hospital, respectively. Colonoscopy is likely not warranted
thrive) (7.3 %). In Gertrude’s hospital, the indications for
in children with recurrent abdominal pain without bleeding,
OGD were recurrent abdominal pain (54.5%), recurrent
weight loss, or altered bowel habit.
emesis (18.2%), FB ingestion (7.3%), upper GI bleed (5,5%),
dysphagia (3.6%) and others. The pattern of the indications
differed significantly in the two facilities with a p-value Endoscopic Findings
of <0.001. This is similar to findings from studies done
Oesophagogastroduodenoscopy
in Nigeria where epigastric pain (37.3%), haematemesis
(28.8%) and dysphagia (15.3%) were the predominant The commonest gastroscopic findings in our study were
indications for OGD [6]. A total of 16 (14.5 %) patients had Gastritis which were findings in 27 (29.7%) of the patients
ingested a material with more presenting at KNH compared to followed by Esophagitis seen in 26 (28.6%) of them and
Gertrude. The main materials they had ingested were button varices in 13 (14.3%), This observation concurs with that of
battery and caustic substances with each hospital having the Pakistan study [10], where gastritis is the commonest
finding accounting for 14.5% of the observations. There Histology Findings

were 6 participants with a gross finding in the pharynx.
This represents 5.5% of all children in both hospitals. Of A total of 69(62.7%) of the patients had results of biopsies
these, majority were Erythema 5(83.3%) and there was taken with Gertrude having a higher proportion 47 (85.5%)
no statistically significant difference in the two hospitals. 3 in compared to 22(40.0%) in KNH. This was a statistically
(50%) of children who had caustic ingestion had erythema significant finding. In terms of procedure, majority of the
or mouth ulcers and this finding contrasts with a finding of existing biopsy results were among those who underwent
a study in Poland where 23.3% of children who ingested OGD 52 (76.5%). Possible reasons for the higher proportion
caustic substances had lesions in the pharynx from the of absent histology results amongst patients in KNH include
ingestion [11]. The pattern of the differences in gross firstly, biopsy not being taken in cases where urgent OGD was
findings in oesophagus in the two hospitals was statistically done like in emergency foreign body removal and banding
significant with a p-value of <0.001. Regarding findings in of bleeding oesophageal varices in unstable patients and
the oesophagus, there were more with normal findings in secondly, loss of the biopsy specimen or histology results. A
Gertrude 26 (52%) compared to KNH 14 (34.1%). This could similar scenario was seen in a study of pediatric GI endoscopy
be probably because of more children with disease needing in Brazil where biopsies were done in 120 (60.3%) of the
therapeutic procedures being brought to KNH where the children [16]. In this study, normal histology was observed
endoscopy services are cheaper compared to the more from the biopsies taken in the esophagus and duodenum at
expensive services at the Gertrude’s children hospital where 82.6% and 88.1% respectively and this is similar to findings
endoscopy is done in a surgical theatre set up. The main in a study in Greece where 68% of the histology from biopsies
finding in the oesophagus was oesophagitis. The findings in the OGD done in children were reported as normal and
under ‘Others’ included oesophageal candidiasis seen in a the study participants were considered to have functional
7 years old child and congenital stenosis which was noted dyspepsia [17]. Our study also showed that the commonest
in an 8 months child in KNH each representing 0.9% of the histological finding in the stomach of the children who
study participants. This finding is similar to a finding in a underwent OGD was superficial gastritis as seen in 28
study in Romania where paediatric infectious oesophagitis (50.9%) of the children, a finding that was also reflected in a
was seen in only 2.11% of patients and was attributed to study in Pakistan where the commonest histological finding
Candidiasis, cytomegalovirus infection and Herpes simplex was gastritis (antral biopsies) [18]. Regarding histological
virus infection [12]. findings on colonoscopy in this study, the commonest findings
were chronic ulcerative colitis, juvenile polyps and lympho-
Congenital esophageal stenosis is a rare cause of nodular hyperplasia seen in 30.8%, 23.1% and 15.4% of the
childhood dysphagia encountered in OGD as confirmed study participants respectively. This is comparable to findings
by a case report in India [13]. In both facilities, a higher in a study in Ethiopia where the commonest histological
proportion had normal findings 41(45.1%) in the stomach findings on colonoscopy were hyperplastic polyps and
and of those with abnormal finding the main finding was juvenile polyps in 32% and 27% respectively [3]. In KNH,
erosive gastritis, 27(29.7%) while in the duodenum the main out of the 15 children who had Colonoscopy, 12 (80%) had
finding was erosions 7 (7.7%). Hiatus hernia was seen in only gross lesions on endoscopic findings and 10 (66.7%) had
4.8% of the children in this study and this is comparable to positive histology findings. In Gertrude’s hospital, out of the
a study done in Nepal where the prevalence of hiatus hernia 8 children who had Colonoscopy 2(25%) had gross lesions
was found to be 3% amongst children up to 15 years who at endoscopy and 3 (37.5%) had positive histology findings.
underwent OGD [14].
Helicobacter Pylori Status
Colonoscopy
In this study, 14 (20.3%) of the study participants whose
There were 8 participants with colonoscopy findings biopsy results were accessible were positive for H.pylori
in Gertrude hospital and all of them had a normal finding infection which differs from a study in Brazil where biopsies
in the colon while in KNH there were 15 participants with of the esophagus, stomach and duodenum were performed
colonoscopy findings and of these 6(40%) had polyps. in 60% of the patients and in 13.1% of the patients, the H.
Regarding the commonest colonoscopic findings in this pylori test was positive [16].
study, 6 (26.1%) had colonic polyps followed by 4 (18.2%)
with rectal polyps then 2 (8.7%) with colonic ulcers and Therapeutic Procedures
another 2 (8.7%) with both rectal ulcers erythema. These
In our study, oesophageal dilatation, PEG tube insertion
findings resemble those in a study done in China where
and FB removal were done in 8.8%, 4.4% and 9.9%
polyps (42.9%) and IBD (16.5%) were the two most common
respectively in the patients who underwent OGD. This is
positive findings [15].
comparable to a retrospective audit of paediatric OGD in
Brazil where esophageal dilatation, PEG tube insertion and Tabbers MM, et al. (2017) Pediatric gastrointestinal
FB removal were done in 0.5%, 2% and 6% of the study endoscopy: European Society of Gastrointestinal
participants, respectively [16]. In Gertrude’s children’s Endoscopy (ESGE) and European Society for Paediatric
hospital, both cases of FB removal involved coins lodged in Gastroenterology, Hepatology and Nutrition (ESPGHAN)
the oesophagus and in KNH, all of the 7 children with button Guideline Executive summary. Endoscopy 49(1): 83-91.
batteries ingested had removal of these objects. This finding
in KNH is similar to a finding in Chile where 22(88%) of the 3. Tamire AH (2020) Clinical Profile and Outcome of
children with ingestion of button batteries had these foreign Pediatric Patients undergoing gastroscopic and
bodies removed [19]. Most of the therapeutic procedures for Colonoscopic procedures at Tikur Anbessa Specialized
the children were done in KNH as compared to Gertrude’s Hospital: A five-year endoscopy trend analysis. Ethiop
children hospital probably because of less expense needed Med J 58(1): 29-32.
for treatment at KNH. In contrast to our study where overall
4. Hayat JO, Sirohi R, Gorard DA (2008) Paediatric endoscopy
12.1% of the children who had OGD in the two hospitals
performed by adult-service gastroenterologists. Eur J
needed banding for oesophageal varices, 3.4% of the study
Gastroenterol Hepatol 20(7): 648-652.
participants needed banding in a study in Nigeria [6]. In
this study, 30.4% of the children who had colonoscopy 5. Friedt M, Welsch S (2013) An update on pediatric
had polypectomy which is similar to a study in Taiwan endoscopy. Eur J Med Res 18(1): 24.
where 20.4% of children who underwent colonoscopy had
polypectomy [20]. 6. Alatise OI, Anyabolu HC, Sowande O, Akinola D (2015)
Paediatric endoscopy by adult gastroenterologists in
Conclusions Ile-Ife, Nigeria: A viable option to increase the access
to paediatric endoscopy in low resource countries. Afr J
1. The higher percentages of normal gross and histologic Paediatr Surg 12(4): 261-265.
findings indicate more a functional than organic etiology
to the gastrointestinal presentations in children who 7. Mudawi HMY, Tahir MAE, Suleiman SH, Eltaybe NH,
undergo endoscopy in our population. Gamer NM, et al. (2009) Paediatric gastrointestinal
2. Hiatus hernia in children is uncommon in our set up. endoscopy: Experience in a Sudanese university hospital.
3. Juvenile polyps are more common than ulcerative colitis East Mediterr Health J 15(4): 1027-1031.
as a cause of hematochezia in children.
4. The higher rates of esophageal dilatations and banding 8. Lin CH, Chen AC, Tsai JD, Wei SH, Hsueh KC, et al. (2007)
for varices in KHN as compared to Gertrude’s children Endoscopic removal of foreign bodies in children.
hospital reflect the higher overall costs of treatment Kaohsiung J Med Sci 23(9): 447-452.
needed for repeat procedures. 9. Shivakumar AM, Naik AS, Prashanth KB, Yogesh BS,
Hongal GF (2004) Foreign body in upper digestive tract.
Recommendations Indian J Pediatr 71(8): 689-693.
1. Considerations for higher possibility of functional 10. Khan MR, Ahmed S, Ali SR, Maheshwari PK, Jamal MS
diagnoses should be made for patients with recurrent (2014) Spectrum of upper GI endoscopy in Pediatric
abdominal pains and recurrent emesis. Population at a Tertiary Care Centre in Pakistan. Open
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Practices in Paediatric Gastrointestinal Endoscopy at Kenyatta National Hospital and Gertrudes Children's Hospital in Nairobi Kenya

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Gastroenterology & Hepatology International Journal

Practices in Paediatric Gastrointestinal Endoscopy at Kenyatta

Keywords: Hematochezia; Dysphagia; Gastritis; Esophagitis; Oesophageal Varices

According to the European Society of Gastrointestinal Ethical Approval

Statistical Analysis Results

Hospital Total (N=110)

Figure 1: Indications for Oesophagogastroduodenoscopy (OGD) in Gertrude and KNH.

Figure 2: Indications for Colonoscopy in Gertrude and KNH.

Varices 0 (0.0%) 2 (4.9%) 2 (2.2%)

Figure 3: OGD findings by hospital.

Figure 4: Colonoscopy findings by hospital.

Gertrude KNH Total

Gertrude KNH Total

Discussion 7 (43.8%) children presenting with each. This is different

finding accounting for 14.5% of the observations. There Histology Findings

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