Abstract Rationale Aerodigestive symptoms in children commonly involve overlapping pathology across the upper airway, lower airway, and gastrointestinal tract. Triple endoscopy, which combines rigid laryngoscopy, flexible bronchoscopy with bronchoalveolar lavage (BAL), and esophagogastroduodenoscopy during a single anesthetic session, offers a comprehensive evaluation and may improve diagnostic efficiency. However, its use varies widely, and there is limited guidance on when triple endoscopy provides advantage over double endoscopy involving only otolaryngology and gastroenterology. This study aimed to compare the clinical characteristics, diagnostic yield, and impact on patient management between triple and double endoscopy to identify patient groups who may benefit most. Methods We performed a retrospective chart review of pediatric patients aged 1 month to 18 years who underwent triple or double endoscopy at a tertiary children’s hospital between January 1, 2022, and June 30, 2023. Triple endoscopy included ENT rigid airway evaluation, flexible bronchoscopy with BAL by pulmonology, and upper endoscopy by gastroenterology. Data collected included demographics, clinical indications, preprocedural imaging, procedural findings, BAL cell count and lipid-laden macrophage staining, pathology results, and post-procedural changes in diagnosis and management. Comparative statistical analyses utilized Wilcoxon rank-sum, Chi-square, and Fisher’s exact tests. Results Sixty patients were included: 39 underwent triple and 21 double endoscopy. Abnormal preprocedural imaging was significantly more common in triple procedures (68.4% vs. 38.1%, p = 0.03). Triple endoscopy was more frequently performed for chronic cough (61.5% vs. 19.0%, p 0.001), dysphagia (64.1% vs. 33.3%, p = 0.008), and aspiration/penetration risk (51.3% vs. 28.6%, p = 0.045). Diagnostic yield was higher in the triple group, which had fewer normal studies (33.3% vs. 61.9%, p = 0.01). Flexible bronchoscopy identified airway abnormalities in 48.7% and secretions in 41%, and BAL showed neutrophilic inflammation in 37.5% of sampled patients, with lipid-laden macrophages positive in 31%. Changes in working diagnosis were significantly more frequent after triple endoscopy (67% vs. 24%, p = 0.001), although management changes were similar (38.5% vs. 33.3%, p = 0.78). Complications were minor and comparable between groups. Conclusion Triple endoscopy provides greater diagnostic clarity in children with multisystem aerodigestive symptoms, particularly in those with chronic cough, dysphagia, aspiration risk, or abnormal imaging. While increased diagnostic yield does not always translate to management change, identifying patient phenotypes most likely to benefit may guide more standardized, value-based procedural selection. This abstract is funded by: NONE
M Nusrat (Fri,) studied this question.