BRUSH CYTOLOGY AS AN ADJUNCT TO UPPER GI ENDOSCOPY
AK Patwari*, Praveen Kumar**, Akshay Kapoor***, VK Anand****, Veena Malhotra*****
Division of Pediatric Gastroenterology & Nutrition, Department of Pediatrics, Lady Hardinge Medical College & Kalavati Saran Children Hospital, GB Pant Hospital, New Delhi. *, Division of Pediatric Gastroenterology & Nutrition, Department of Pediatrics, Lady Hardinge Medical College & Kalavati Saran Children Hospital, GB Pant Hospital, New Delhi. **, Division of Pediatric Gastroenterology & Nutrition, Department of Pediatrics, Lady Hardinge Medical College & Kalavati Saran Children Hospital, GB Pant Hospital, New Delhi. ***, Division of Pediatric Gastroenterology & Nutrition, Department of Pediatrics, Lady Hardinge Medical College & Kalavati Saran Children Hospital, GB Pant Hospital, New Delhi. ****, Department of Pathology, GB Pant Hospital, New Delhi*****
Introduction: Upper GI endoscopy is an established diagnostic procedure in children and is performed in various gastrointestinal symptoms. Here we are presenting our experience of endoscopic brush cytology in children who were subjected to upper GI endoscopy.

Aim: To study the diagnostic utility of endoscopic brush cytology in children.

Material & Methods: Children subjected to upper GI endoscopy for various gastrointestinal symptoms constituted material for the study. Endoscopic brush cytology (EBC) was performed in the antrum and duodenum in addition to endoscopic grasp biopsy from these sites. The brush cytology slides were examined for H. pylori and Giardia. Endoscopic grasp forcep biopsies (EGB) were subjected to routine histological examination.

Results: 175 consecutive patients (1-14 years) who underwent upper GI endoscopies for various symptoms like chronic diarrhea, recurrent abdominal pain and vomiting/regurgitation were studied. 25 children (14.28%) were colonized by H. pylori and 28 children (16%) were colonized by Giardia while 5 cases (2.8%) were colonized by both. Out of these 25 cases of H. pylori, 21 cases were detected by EGB & 15 cases with EBC. Out of 28 cases of giardia 17 cases were detected by EBG while 24 (85.7%) were detected by EBC. Our observation highlights that 4 cases (16%) of H. pylori & 11 cases (39%) of Giardia detected by EBC were missed by EGB. There was no complication associated with EBC & the procedure time for endoscopy was not significantly prolonged.

Discussion & Conclusion: EGB may miss to detect H. pylori and Giardia due to uneven distribution. EBC provides a larger area of gastric and duodenal mucosa compared to EGB and thus enhances recovery of H. pylori and giardia. Our result suggests that EBC is a useful diagnostic modality for H. Pylori and Giardia, which enhances detection of these organisms and this should be used as an adjunct to EGB.
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