Objective: Diagnostic testing for recurrent croup may include a “triple endoscopy”, consisting of direct laryngoscopy & bronchoscopy (DLB), flexible bronchoscopy and lavage (BAL), and esophagogastroduodenoscopy (EGD). The purpose of this study was to assess the diagnostic utility of triple endoscopy in children with recurrent croup.
Method: A retrospective chart review was performed on pediatric patients (age <18 years) with a history of recurrent croup evaluated by triple endoscopy at a tertiary care pediatric hospital from 2010 to 2021. Data including presenting symptoms, airway findings, BAL and EGD findings and biopsy results were collected.
Results: 44 patients with recurrent croup underwent triple endoscopy. The mean age was 4.3 ± 2.94 years old. The most common symptom was chronic cough among 40 (90.9%) patients, while 13 (29.5%) had gastrointestinal symptoms (GI), and 10 (22.7%) had a history of intubation due to critical illness. The most common airway findings were tracheomalacia (19 patients) and laryngeal cleft (19 patients). On EGD biopsy, 17 (38.6%) had esophagitis with 5 having greater than 15 eosinophils/hpf suggestive of eosinophilic esophagitis. 52.3% of patients with GI symptoms had abnormal findings on GI biopsy versus 47.4% without GI symptoms (p = 0.76). Positive culture on BAL was found in 18 (40.9%) patients.
Conclusion: Abnormal EGD and BAL findings on triple endoscopy were common in children with recurrent croup. There was no significant correlation between history of gastrointestinal symptoms with abnormal EGD findings. This suggests triple endoscopy has some benefit in patients with recurrent croup even without obvious GI symptoms.