Division of Gastroenterology, Hepatology and Nutrition and the Research and Learning Institutes, The Hospital for Sick Children, Department of Paediatrics and the Wilson Centre, University of Toronto, Toronto, Ontario, Canada.
Division of Gastroenterology and Nutrition, UMass Memorial Children's Medical Center, Department of Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
Gastrointest Endosc. 2022 Oct;96(4):593-602. doi: 10.1016/j.gie.2022.06.016. Epub 2022 Aug 24.
Current endoscopy quality guidelines largely focus on cancer screening-related metrics that are not applicable to pediatric populations. Through an international Pediatric Endoscopy Quality Improvement Network (PEnQuIN), quality standards and indicators for pediatric endoscopic procedures were developed and endorsed by the American Society for Gastrointestinal Endoscopy (ASGE).
The Appraisal of Guidelines for REsearch and Evaluation II instrument guided PEnQuIN members, from 31 centers representing 11 countries, in generating and refining proposed quality standards and indicators. Quality of evidence and strength of recommendations were rated according to the Grading of Recommendation Assessment, Development, and Evaluation approach. Consensus on reporting elements was sought with an iterative online Delphi process.
Forty-nine quality standards and 47 indicators, encompassing pediatric endoscopy facilities, procedures, and endoscopists, as well as 30 reporting elements essential for inclusion within a pediatric endoscopy report reached consensus. Minimal acceptable standards were defined for 3 key indicators related to pediatric lower endoscopy: terminal ileal intubation rate ≥85%, cecal intubation rate ≥90%, and rate of adequate bowel preparation ≥80%. There was strong consensus that terminal ileal intubation, rather than cecal intubation, is integral to ensuring high-quality endoscopic care in children.
The PEnQuIN guidelines establish international agreement on clinically meaningful metrics tailored to pediatric endoscopy that can be used to promote safe, high-quality, patient- and family-centered endoscopic care. Moving forward, it is recommended that all providers and facilities involved in endoscopy service for children adopt the PEnQuIN standards, indicators, and key reporting elements outlined in these ASGE-endorsed guidelines.
目前的内镜质量指南主要侧重于与癌症筛查相关的指标，但这些指标不适用于儿科人群。通过一个国际儿科内镜质量改进网络（PEnQuIN），制定了儿科内镜操作的质量标准和指标，并得到了美国胃肠内镜学会（ASGE）的认可。
评估研究和评估 II 工具指导 PEnQuIN 成员（来自代表 11 个国家的 31 个中心）生成和完善拟议的质量标准和指标。根据推荐评估、制定和评估方法（Grading of Recommendation Assessment, Development, and Evaluation approach）对证据质量和建议强度进行评级。通过迭代在线 Delphi 流程寻求报告要素的共识。
达成共识的有 49 项质量标准和 47 项指标，涵盖儿科内镜设施、程序和内镜医生，以及 30 项报告要素，这些要素对于纳入儿科内镜报告至关重要。与儿科下内镜相关的 3 个关键指标（回肠末段插管率≥85%、盲肠插管率≥90%和肠道准备充分率≥80%）定义了最低可接受标准。强烈共识是，儿科内镜护理的质量保证离不开回肠末段插管，而不是盲肠插管。
PEnQuIN 指南就儿科内镜量身定制的具有临床意义的指标达成了国际共识，这些指标可用于促进安全、高质量、以患者和家庭为中心的内镜护理。未来，建议所有参与儿童内镜服务的提供者和机构采用 ASGE 认可的这些指南中概述的 PEnQuIN 标准、指标和关键报告要素。
