Routine Coagulation Screening in Children Undergoing Gastrointestinal Endoscopy Does Not Predict Those at Risk of Bleeding

Background and Study Aims: Routine coagulation screening prior to gastrointestinal endoscopy is performed in many centres in the UK, despite the lack of any evidence to support the practice. The aim of this study was to assess the benefits of routine pre-endoscopy coagulation screening in children and to assess how widespread this practice is in the UK.
Patients and Methods: We performed a retrospective analysis of the case notes of 250 consecutive patients who had undergone routine coagulation screening prior to endoscopy and biopsy, in accordance with our unit’s protocol, looking for evidence of abnormal results or episodes of bleeding. We also performed a telephone survey of the protocols for coagulation screening at other paediatric units in the UK which are known to perform gastrointestinal endoscopy on a routine basis.
Results: According to our hospital’s laboratory reference ranges, 16.8 % of the children who underwent endoscopy and biopsy had abnormal clotting. This was neither clinically significant nor associated with an increased bleeding risk in any patient. Of the 23 UK paediatric gastroenterology centres surveyed, including our own, five (21.7 %) perform routine coagulation screening before endoscopy.
Conclusions: This study suggests that, although it is a relatively common practice, routine coagulation screening is not indicated in children who are undergoing gastrointestinal endoscopy and biopsy, and that it does not predict those at risk of significant bleeding. We would therefore suggest that if pre-endoscopy screening is to be performed, it should be reserved for those who are potentially at high risk of bleeding.

References

• 1 Kozak E A, Brath L K. Do “screening” coagulation tests predict bleeding patients undergoing fibreoptic bronchoscopy with biopsy?.  Chest. 1994;  106 703-705
• 2 Rohrer M J, Michelotti M C, Nahrwold D L. A prospective evaluation of the efficacy of preoperative coagulation testing.  Ann Surg. 1988;  208 554-557
• 3 Burk C D, Miller L, Handler S D, Cohen A R. Preoperative history and coagulation screening in children undergoing tonsillectomy.  Paediatrics. 1992;  89 691-695
• 4 ASGE .Position statement on laboratory testing before ambulatory elective endoscopic procedures. American Society of Gastrointestinal Endoscopy 2002 http://www.asge.org
• 5 Viiala C H, Zimmerman M, Cullen D J, Hoffman N E. Complication rates of colonoscopy in an Australian teaching hospital environment.  Intern Med J. 2003;  33 355-359