Division of Gastroenterology and Hepatology, Stanford University School of Medicine.
Division of Pediatric Gastroenterology, Lucille Packard Children's Hospital at Stanford University Medical Center, Stanford, CA.
J Pediatr Gastroenterol Nutr. 2019 Jul;69(1):24-31. doi: 10.1097/MPG.0000000000002310.
Endoscopic procedures are important for diagnosis and management of many gastrointestinal, liver, and biliary conditions in children. Therapeutic endoscopy procedures, including endoscopic retrograde cholangiopancreatography (ERCP), are performed less frequently in children relative to adults. A formal study to evaluate institutional volumes and practice patterns for advanced therapeutic pediatric endoscopy procedures has, however, not been previously undertaken.
A self-administered 16-question (5-minute) online survey assessing practice patterns for performance of pediatric endoscopy procedures was distributed to all registered North American Society for Pediatric Gastroenterology, Hepatology and Nutrition programs. Results were analyzed using descriptive statistics and thematic analysis of free-text comments.
Respondents from 82.9% of North American Society for Pediatric Gastroenterology, Hepatology and Nutrition centers completed this survey. Responses revealed that esophagogastroduodenoscopy/colonoscopy are performed at the vast majority of centers (>90%), with most performing >50/year. Therapeutic endoscopy procedures are performed less frequently in the pediatric population, with 18.97% reporting that ERCP is not performed at their institution. Where ERCP is performed, 91.38% reported <25/year. Endoscopic ultrasound is not performed at more than half (53.33%) of institutions. Approximately 71.67% of respondents do not believe their institution's current arrangement for performing pediatric therapeutic endoscopy procedures is adequate.
Although the range of endoscopic procedures performed in children parallels that performed in adults, there are notable differences in pediatric and adult gastroenterologists' endoscopy training and procedure volumes. Our results and respondent comments suggest that pediatric patients would benefit from a partnership between pediatric and adult gastroenterologists, with adult gastroenterologists performing more complex therapeutic endoscopic procedures.
内镜检查对于儿童胃肠道、肝脏和胆道疾病的诊断和治疗非常重要。与成人相比，儿童的治疗性内镜检查（包括内镜逆行胰胆管造影术 [ERCP]）相对较少。然而，尚未对机构内高级治疗性儿科内镜检查程序的容量和实践模式进行正式研究。
我们向所有注册的北美儿科胃肠病学、肝脏病学和营养学会中心分发了一份 16 个问题（5 分钟）的在线调查，评估执行儿科内镜检查程序的实践模式。使用描述性统计和自由文本评论的主题分析来分析结果。
来自北美儿科胃肠病学、肝脏病学和营养学会中心的 82.9%的受访者完成了这项调查。调查结果显示，食管胃十二指肠镜/结肠镜检查在绝大多数中心（>90%）进行，大多数中心每年进行>50 次。在儿科人群中，治疗性内镜检查的频率较低，有 18.97%的机构表示其机构未进行 ERCP。在进行 ERCP 的机构中，91.38%报告每年进行<25 次。超过一半（53.33%）的机构未进行内镜超声检查。大约 71.67%的受访者认为其机构目前执行儿科治疗性内镜检查程序的安排不足。
尽管儿童进行的内镜检查范围与成人相似，但儿科和成人胃肠病学家的内镜检查培训和程序量存在显著差异。我们的结果和受访者的评论表明，儿科患者将受益于儿科和成人胃肠病学家之间的合作，由成人胃肠病学家执行更复杂的治疗性内镜检查。
