{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T07:07:12Z","timestamp":1784185632281,"version":"3.55.0"},"reference-count":38,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Sage Open Medicine"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The objective of this study was to provide the first multicenter evaluation of pediatric gastrointestinal endoscopy in Palestine, specifically characterizing clinical indications, sedation practices, diagnostic and histopathologic yield, and outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study was conducted across multiple hospitals in the West Bank, Palestine, including patients \u226418 years who underwent gastrointestinal endoscopy between January 2019 and December 2023.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 245 pediatric endoscopic procedures were performed across participating centers (mean age 15.2 \u00b1 2.9 years; 51.0% female). Of these, 149 were upper endoscopies and 96 were lower endoscopies. Abnormal findings were documented in 113 upper endoscopies (75.8%), most commonly gastritis, esophagitis, and duodenitis, and in 72 lower endoscopies (75.0%), including colitis, polyps, and terminal ileitis. Biopsies were submitted in 186 procedures (75.9%), with histopathological abnormalities confirmed in 127 cases (68.3% of biopsied specimens). The most frequent final diagnosis was gastritis (n = 68; 27.8%), including\n                      <jats:italic toggle=\"yes\">Helicobacter pylori<\/jats:italic>\n                      -associated and nodular gastropathy, followed by esophagitis (n = 17; 6.9%), Crohn\u2019s disease (n = 10; 4.1%), and ulcerative colitis (n = 10; 4.1%). Patients who underwent lower endoscopy were significantly older (mean age 16.3 \u00b1 1.8 years) compared with those undergoing upper endoscopy (14.6 \u00b1 3.2 years) or combined procedures (15.6 \u00b1 3.0 years; p &lt; 0.001). The chief presenting complaint was diarrhea (n = 24; 9.8%) and inflammatory bowel disease symptoms (n = 10; 4.1%) when patients underwent lower endoscopy, whereas the chief presenting complaint was abdominal pain (n = 54; 22.0%) and nausea\/vomiting (n = 16; 6.5%) when patients underwent upper endoscopy.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This multicenter study demonstrates that pediatric gastrointestinal endoscopy in Palestine yields a high diagnostic rate, with abnormal findings documented in approximately three-quarters of both upper and lower procedures. The findings primarily emphasize the importance of strengthening biopsy protocols and diagnostic pathways in resource-limited healthcare systems.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/20503121261469061","type":"journal-article","created":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T15:02:16Z","timestamp":1783954936000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical indications and outcomes of pediatric gastrointestinal endoscopy in a resource-limited healthcare system: Findings from the first multicenter study"],"prefix":"10.1177","volume":"14","author":[{"given":"Shahd","family":"Abu Halima","sequence":"first","affiliation":[{"name":"An-Najah National University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khadija","family":"Salhab","sequence":"additional","affiliation":[{"name":"An-Najah National University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bayan","family":"Al-Thuluth","sequence":"additional","affiliation":[{"name":"An-Najah National University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayah","family":"Nassar","sequence":"additional","affiliation":[{"name":"An-Najah National University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iyad","family":"Maqboul","sequence":"additional","affiliation":[{"name":"An-Najah National University"},{"name":"An-Najah National University Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"Jaber","sequence":"additional","affiliation":[{"name":"An-Najah National University"},{"name":"An-Najah National University Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2403-610X","authenticated-orcid":false,"given":"Ramzi","family":"Shawahna","sequence":"additional","affiliation":[{"name":"An-Najah National University"},{"name":"An-Najah National University Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,7,13]]},"reference":[{"issue":"1","key":"e_1_3_7_2_2","first-page":"83","article-title":"Pediatric gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) and European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) Guideline Executive summary","volume":"49","author":"Tringali A","year":"2017","unstructured":"Tringali A, Thomson M, Dumonceau JM, et al. Pediatric gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) and European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) Guideline Executive summary. Endoscopy 2017; 49(1): 83\u201391, PubMed PMID: 27617420. https:\/\/doi.org\/10.1055\/S-0042-111002\/ID\/JR14505-6\/BIB","journal-title":"Endoscopy"},{"key":"e_1_3_7_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.giec.2022.10.001"},{"key":"e_1_3_7_4_2","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2021.715912"},{"key":"e_1_3_7_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/PG9.0000000000000224"},{"key":"e_1_3_7_6_2","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2025.1691692"},{"key":"e_1_3_7_7_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11894-023-00897-2"},{"key":"e_1_3_7_8_2","doi-asserted-by":"publisher","DOI":"10.1093\/ajcp\/aqae074"},{"key":"e_1_3_7_9_2","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2023.1201593"},{"key":"e_1_3_7_10_2","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2023-063678K"},{"key":"e_1_3_7_11_2","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v29.i18.2717"},{"key":"e_1_3_7_12_2","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2024.1379101"},{"key":"e_1_3_7_13_2","doi-asserted-by":"publisher","DOI":"10.4253\/wjge.v2.i7.257"},{"key":"e_1_3_7_14_2","doi-asserted-by":"publisher","DOI":"10.14740\/jmc4013"},{"issue":"1","key":"e_1_3_7_15_2","first-page":"6501215","article-title":"Safety of Propofol versus Nonpropofol-Based Sedation in Children Undergoing Gastrointestinal Endoscopy: A Systematic Review and Meta-Analysis","volume":"2018","author":"Narula N","year":"2018","unstructured":"Narula N, Masood S, Shojaee S, et al. Safety of Propofol versus Nonpropofol-Based Sedation in Children Undergoing Gastrointestinal Endoscopy: A Systematic Review and Meta-Analysis. Gastroenterol Res Pract 2018; 2018(1): 6501215. https:\/\/doi.org\/10.1155\/2018\/6501215","journal-title":"Gastroenterol Res Pract"},{"key":"e_1_3_7_16_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2016-011384"},{"key":"e_1_3_7_17_2","unstructured":"Palestinian Central Bureau of Statistics (PCBS). Estimated Population in Palestine Mid-Year by Governorate 1997- 2026 2026. [cited 2026 May 5] Available from: https:\/\/www.pcbs.gov.ps\/en\/statistics\/?selectedItemId=db2e164c-1778-4502-80ab-1b483cc5b500&tableCategory=collapse5141&table_id=676&tabletype=1"},{"key":"e_1_3_7_18_2","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2025.1670440"},{"key":"e_1_3_7_19_2","doi-asserted-by":"publisher","DOI":"10.5009\/gnl250261"},{"key":"e_1_3_7_20_2","doi-asserted-by":"publisher","DOI":"10.1017\/S1368980007000481"},{"key":"e_1_3_7_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2017.06.037"},{"key":"e_1_3_7_22_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm10215087"},{"key":"e_1_3_7_23_2","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2021.607418"},{"key":"e_1_3_7_24_2","doi-asserted-by":"publisher","DOI":"10.1093\/qjmed\/hcae175.826"},{"key":"e_1_3_7_25_2","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2021.687635"},{"key":"e_1_3_7_26_2","doi-asserted-by":"publisher","DOI":"10.1055\/a-2416-4866"},{"key":"e_1_3_7_27_2","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000003947"},{"key":"e_1_3_7_28_2","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2021.709433"},{"key":"e_1_3_7_29_2","doi-asserted-by":"publisher","DOI":"10.3390\/app9235036"},{"key":"e_1_3_7_30_2","doi-asserted-by":"publisher","DOI":"10.1097\/MPG.0000000000002310"},{"key":"e_1_3_7_31_2","doi-asserted-by":"publisher","DOI":"10.1111\/ped.14721"},{"key":"e_1_3_7_32_2","doi-asserted-by":"publisher","DOI":"10.3390\/gidisord5030029"},{"key":"e_1_3_7_33_2","doi-asserted-by":"publisher","DOI":"10.1097\/MPG.0000000000003710"},{"key":"e_1_3_7_34_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.pathol.2021.09.023"},{"key":"e_1_3_7_35_2","doi-asserted-by":"publisher","DOI":"10.1080\/00365521.2022.2057197"},{"key":"e_1_3_7_36_2","doi-asserted-by":"publisher","DOI":"10.32074\/1591-951X-734"},{"key":"e_1_3_7_37_2","first-page":"S16","article-title":"Pediatric Endoscopy Quality Improvement Network Quality Standards and Indicators for Pediatric Endoscopy Facilities: A Joint NASPGHAN\/ESPGHAN Guideline","volume":"74","author":"Lightdale JR","year":"2022","unstructured":"Lightdale JR, Walsh CM, Narula P, et al. Pediatric Endoscopy Quality Improvement Network Quality Standards and Indicators for Pediatric Endoscopy Facilities: A Joint NASPGHAN\/ESPGHAN Guideline. 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