PMID- 30554708
OWN - NLM
STAT- MEDLINE
DCOM- 20190128
LR  - 20190128
IS  - 1872-8464 (Electronic)
IS  - 0165-5876 (Linking)
VI  - 116
DP  - 2019 Jan
TI  - The diagnostic role of triple endoscopy in pediatric patients with chronic cough.
PG  - 58-61
LID - S0165-5876(18)30529-9 [pii]
LID - 10.1016/j.ijporl.2018.10.017 [doi]
AB  - OBJECTIVE/HYPOTHESIS: Multi-disciplinary aero-digestive centers provide high 
      quality health care through improved outcomes and treatment costs over separate 
      sub specialty clinics. These outcomes are often the result of a common 
      investigative tool known as triple endoscopy: a rigid bronchoscopy performed by 
      an otolaryngologist, flexible bronchoscopy and lavage obtained by a 
      pulmonologist, and an endoscopy with guided biopsies performed by a 
      gastroenterologist. Combining such procedures into one 'triple endoscopy' allows 
      for diagnoses which otherwise might have been missed with just one procedure. The 
      goal of our study was to describe the efficacy of the triple endoscopy procedure 
      in diagnosing recalcitrant aero-digestive conditions, specifically chronic cough. 
      STUDY DESIGN: Retrospective chart review METHODS: Multiple charts from children 
      who underwent the triple endoscopy for chronic cough were retrospectively 
      reviewed from 2005 and 2017. Complete data from the triple procedure was gathered 
      on 243 patients, including findings by sub specialty (otolaryngology, 
      pulmonology, and gastroenterology). RESULTS: Of the 243 patients with complete 
      data who underwent triple endoscopy, 203 (83.5%) children had at least one 
      positive finding. Of these children, 101 (41.5%) had one specialty specific 
      diagnosis, and 102 (42%) had multiple cross specialty diagnoses. When describing 
      the diagnoses, 63 children had gastro esophageal reflux (GER), 14 had 
      eosinophilic esophagitis (EoE), 118 had tracheomalacia, 54 had laryngeal clefts, 
      and 102 children had positive bronchoalveolar lavages. Outcome data was available 
      on 226 patients (93%), of these patients, 188 patients had a diagnosis from the 
      triple scope. Of those patients with a diagnosis and outcome data, 144 (76.6%) 
      children had an improved outcome as a result of a treatment plan targeting that 
      diagnosis, while 16 of the 37 patients without a diagnosis improved. This 
      difference was significant by chi square analysis (p<0.0001). CONCLUSION: The 
      triple scope procedure is a useful investigative tool for patients with 
      recalcitrant aero-digestive complaints like chronic cough. In particular, triple 
      scope can yield more than one specialty specific diagnosis, normally missed by 
      one procedure. The triple scope also leads to improved parental satisfaction by 
      improved cost and healthcare outcomes.
CI  - Copyright (c) 2018. Published by Elsevier B.V.
FAU - Fracchia, M Shannon
AU  - Fracchia MS
AD  - Airway and Swallowing Center Massachusetts Eye and Ear Infirmary, Assistant 
      Pediatrician Massachusetts General Hospital for Children, Instructor Harvard 
      Medical School, 275 Cambridge Street, Boston, Ma, 02114, United States. 
      Electronic address: mfracchia@partners.org.
FAU - Diercks, Gillian
AU  - Diercks G
AD  - MPH Massachusetts Eye and Ear Infirmary, United States.
FAU - Cook, Anna
AU  - Cook A
AD  - Massachusetts General Hospital for Children, United States.
FAU - Hersh, Cheryl
AU  - Hersh C
AD  - Massachusetts General Hospital for Children, United States.
FAU - Hardy, Stephen
AU  - Hardy S
AD  - Massachusetts General Hospital for Children, United States.
FAU - Hartnick, Marina
AU  - Hartnick M
AD  - Hamilton College, United States.
FAU - Hartnick, Christopher
AU  - Hartnick C
AD  - Pediatric Department Massachusetts Eye and Ear Infirmary, Airway and Swallowing 
      Center Massachusetts Eye and Ear Infirmary, United States.
LA  - eng
PT  - Journal Article
DEP - 20181013
PL  - Ireland
TA  - Int J Pediatr Otorhinolaryngol
JT  - International journal of pediatric otorhinolaryngology
JID - 8003603
SB  - IM
MH  - Adolescent
MH  - Biopsy
MH  - Bronchoalveolar Lavage/*methods/statistics & numerical data
MH  - Bronchoscopy/*methods/statistics & numerical data
MH  - Child
MH  - Child, Preschool
MH  - Chronic Disease
MH  - Cough/*diagnosis/etiology
MH  - Endoscopy, Gastrointestinal/*methods/statistics & numerical data
MH  - Female
MH  - Gastroenterology/methods
MH  - Humans
MH  - Infant
MH  - Male
MH  - Otolaryngology/methods
MH  - Pulmonary Medicine/methods
MH  - Retrospective Studies
MH  - Young Adult
OTO - NOTNLM
OT  - Aero digestive center
OT  - Pediatric chronic cough
OT  - Triple Endoscopy
EDAT- 2018/12/18 06:00
MHDA- 2019/01/29 06:00
CRDT- 2018/12/18 06:00
PHST- 2018/07/17 00:00 [received]
PHST- 2018/10/10 00:00 [revised]
PHST- 2018/10/11 00:00 [accepted]
PHST- 2018/12/18 06:00 [entrez]
PHST- 2018/12/18 06:00 [pubmed]
PHST- 2019/01/29 06:00 [medline]
AID - S0165-5876(18)30529-9 [pii]
AID - 10.1016/j.ijporl.2018.10.017 [doi]
PST - ppublish
SO  - Int J Pediatr Otorhinolaryngol. 2019 Jan;116:58-61. doi: 
      10.1016/j.ijporl.2018.10.017. Epub 2018 Oct 13.