From the Children's Hospital Los Angeles, Los Angeles, CA.
the University of Colorado Department of Pediatrics/Children's Hospital Colorado, Aurora, CO.
J Pediatr Gastroenterol Nutr. 2023 Sep 1;77(3):407-412. doi: 10.1097/MPG.0000000000003864. Epub 2023 Jun 26.
Pediatric advanced endoscopy consists primarily of endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) and is becoming more common in pediatrics. This study aims to characterize the current landscape of pediatric advanced endoscopy training and practice by directly surveying independently practicing pediatric advanced endoscopists (PAEs). We also aim to ascertain expert opinion on competency in pediatric ERCP and EUS.
A 66-question REDCap survey and a 73-question Qualtrics survey were distributed to members of the ERCP Special Interest Group of North American Society of Pediatric Gastroenterology, Hepatology, and Nutrition. Respondents currently performing ERCP or EUS independently in children were included. Statistical analysis was performed using Mann-Whitney U test.
Of 41 PAEs surveyed, 38 (92.7%) responded and 27 independent practitioners were included. Thirteen respondents performed EUS. PAEs who completed an advanced endoscopy fellowship (AEF) were more comfortable performing American Society for Gastrointestinal Endoscopy grade 3 or grade 4 ERCPs ( P < 0.0008) and felt more prepared to practice EUS independently than other trainees. Expert opinion of PAEs felt a threshold of 200 procedures was needed to attain competency in either ERCP or EUS. Pediatric duodenoscope exposure improved comfort in performing ERCP in children <10 kg ( P = 0.009).
Training of pediatric gastroenterologists in ERCP and EUS are highly variable, though the skills attained are similar. AEF-trained specialists reported greater training volumes and felt more prepared to practice independently than those who did not. Competency thresholds determined by expert PAEs for ERCP and EUS agree with American Society for Gastrointestinal Endoscopy guidelines for adult advanced endoscopy trainees.
儿科高级内镜主要包括内镜逆行胰胆管造影术（ERCP）和内镜超声检查（EUS），在儿科中越来越常见。本研究旨在通过直接调查独立进行儿科高级内镜检查的医生（PAE）来描述儿科高级内镜培训和实践的现状。我们还旨在确定专家对小儿 ERCP 和 EUS 能力的意见。
向北美小儿胃肠病学、肝病学和营养学会 ERCP 特别兴趣小组的成员分发了一份 66 个问题的 REDCap 调查和一份 73 个问题的 Qualtrics 调查。包括目前独立为儿童进行 ERCP 或 EUS 的受访者。使用 Mann-Whitney U 检验进行统计分析。
在接受调查的 41 名 PAE 中，有 38 名（92.7%）做出了回应，其中 27 名独立从业者被纳入研究。有 13 名受访者进行了 EUS。完成高级内镜学研究金（AEF）培训的 PAE 更愿意进行美国胃肠内镜学会（ASGE）分级 3 或 4 的 ERCP（P<0.0008），并且比其他受训者更有信心独立进行 EUS 实践。PAE 的专家意见认为，需要完成 200 例操作才能达到在 ERCP 或 EUS 方面的能力。儿科十二指肠镜的使用经验提高了在体重<10kg 的儿童中进行 ERCP 的舒适度（P=0.009）。
小儿胃肠病学家在 ERCP 和 EUS 方面的培训差异很大，但所获得的技能相似。接受 AEF 培训的专家报告说培训量更大，并且比未接受培训的专家更有信心独立进行实践。由专家 PAE 确定的 ERCP 和 EUS 能力阈值与美国胃肠内镜学会成人高级内镜培训学员的指南一致。
