The Benefits and Harms of Endoscopy and Other Diagnostic Tests to Detect Underlying Conditions in Children With Faltering Weight: Technical Report

BACKGROUND AND OBJECTIVE Faltering weight (previously known as “failure to thrive”) is a condition characterized by poor weight gain and has varied underlying etiologies that may require distinct diagnostic evaluations. This technical report describes systematic reviews to identify the benefits and harms of diagnostic tests, including endoscopy, in children younger than 5 years who live in high-income countries. METHODS Two systematic reviews were conducted to assess the evidence regarding benefits and harms of diagnostic tests (including endoscopy) in these children. The search was conducted in electronic databases PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Cochrane Library up to September 27, 2022. Two review team members screened extracted data from potentially eligible articles independently and in duplicate. The Grading of Recommendations, Assessments, Development, and Evaluation (GRADE) approach was used to assess the certainty (eg, quality) of evidence. RESULTS Six studies met inclusion criteria for the benefits and harms of a subset of diagnostic tests. The studies reported on the prevalence of underlying conditions; 2 of these studies also discussed test accuracy. Nine studies met inclusion criteria for evidence on the benefits and harms of endoscopy as a diagnostic tool. Seven studies discussed endoscopic diagnosis, 2 studies discussed histological findings, and 1 discussed procedural complications. The certainty in the evidence was very low because of concerns with risk of bias, inconsistency, and indirectness. CONCLUSIONS Diagnostic testing for underlying conditions in children who are suspected of having faltering weight should be performed at the clinician’s discretion, on the basis of the child’s condition, while considering tests’ potential harms and costs. Future research is needed to better characterize the benefits and harms of evaluations in young children who are being assessed for faltering weight.