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Mahoney LB, Huang JS, Lightdale JR, Walsh CM. Pediatric endoscopy: how can we improve patient outcomes and ensure best practices? Expert Rev Gastroenterol Hepatol 2024; 18:89-102. [PMID: 38465446 DOI: 10.1080/17474124.2024.2328229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 03/05/2024] [Indexed: 03/12/2024]
Abstract
INTRODUCTION Strategies to promote high-quality endoscopy in children require consensus around pediatric-specific quality standards and indicators. Using a rigorous guideline development process, the international Pediatric Endoscopy Quality Improvement Network (PEnQuIN) was developed to support continuous quality improvement efforts within and across pediatric endoscopy services. AREAS COVERED This review presents a framework, informed by the PEnQuIN guidelines, for assessing endoscopist competence, granting procedural privileges, audit and feedback, and for skill remediation, when required. As is critical for promoting quality, PEnQuIN indicators can be benchmarked at the individual endoscopist, endoscopy facility, and endoscopy community levels. Furthermore, efforts to incorporate technologies, including electronic medical records and artificial intelligence, into endoscopic quality improvement processes can aid in creation of large-scale networks to facilitate comparison and standardization of quality indicator reporting across sites. EXPERT OPINION PEnQuIN quality standards and indicators provide a framework for continuous quality improvement in pediatric endoscopy, benefiting individual endoscopists, endoscopy facilities, and the broader endoscopy community. Routine and reliable measurement of data, facilitated by technology, is required to identify and drive improvements in care. Engaging all stakeholders in endoscopy quality improvement processes is crucial to enhancing patient outcomes and establishing best practices for safe, efficient, and effective pediatric endoscopic care.
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Affiliation(s)
- Lisa B Mahoney
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, USA
| | - Jeannie S Huang
- Rady Children's Hospital, San Diego, CA and University of California San Diego, La Jolla, CA, USA
| | - Jenifer R Lightdale
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, USA
| | - Catharine M Walsh
- Division of Gastroenterology, Hepatology and Nutrition and the Research and Learning Institutes, The Hospital for Sick Children, Department of Paediatrics and the Wilson Centre, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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2
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Mahoney LB, Walsh CM, Lightdale JR. Promoting Research that Supports High-Quality Gastrointestinal Endoscopy in Children. Curr Gastroenterol Rep 2023; 25:333-343. [PMID: 37782450 DOI: 10.1007/s11894-023-00897-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2023] [Indexed: 10/03/2023]
Abstract
PURPOSE OF REVIEW Defining and measuring the quality of endoscopic care is a key component of performing gastrointestinal endoscopy in children. The purpose of this review is to discuss quality metrics for pediatric gastrointestinal endoscopy and identify where additional research is needed. RECENT FINDINGS Pediatric-specific standards and indicators were recently defined by the international Pediatric Endoscopy Quality Improvement Network (PEnQuIN) working group through a rigorous guideline consensus process. Although the aim of these guidelines is to facilitate best practices for safe and high-quality gastrointestinal endoscopy in children, they highlight the pressing need to expand upon the body of evidence supporting these standards and indicators as predictors of clinically relevant outcomes. In this review, we propose and discuss ideas for several high-yield research topics to engage pediatric endoscopists and promote best practices in pediatric endoscopy.
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Affiliation(s)
- Lisa B Mahoney
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Catharine M Walsh
- Division of Gastroenterology, Hepatology and Nutrition and the Research and Learning Institutes, The Hospital for Sick Children, Department of Paediatrics and the Wilson Centre, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jenifer R Lightdale
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA.
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3
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Armstrong DG, Chumpitazi BP, Chiou EH, Balakrishnan K. Diagnostic Utility of Mucosal Biopsies Taken During Colonoscopy-Guided Colonic Manometry Catheter Placement. J Pediatr Gastroenterol Nutr 2023; 77:655-660. [PMID: 37548490 DOI: 10.1097/mpg.0000000000003907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
OBJECTIVES The diagnostic utility of mucosal biopsies taken during colonoscopy-guided colonic manometry catheter placement is unknown. The aims of our study were to determine the frequency and histopathology results of mucosal biopsies during these procedures and to assess whether there were any associations between the histology or gross findings with manometry results. METHODS We performed a retrospective chart review of children who had a colonic manometry study completed between 2008 and 2020 at a quaternary children's hospital. We captured patient demographics, biopsy locations, histopathology results, gross endoscopy findings, and manometry results. The chi-squared test and when appropriate Fisher exact test was used to evaluate categorical associations. RESULTS One hundred forty-eight patients were included. One hundred eighteen (80%) had colonic biopsy and 63 (43%) had ileal biopsy. Colonic histology findings, which patients could have multiple, included lymphonodular hyperplasia (34%), normal (27%), chronic inflammation (24%), melanosis coli (21%), colonic eosinophilia (10%), and acute inflammation (8%). Ileal histology findings included increased Peyer patches (44%), normal (44%), acute inflammation (11%), chronic inflammation (3%), eosinophilia (5%), and eosinophilic ileitis (3%). The majority of acute and chronic inflammation was graded as mild. There were no statistically significant associations of histology to gross endoscopy or manometry findings. CONCLUSIONS Colonic biopsies are obtained in the majority of patients presenting for colonic manometry evaluation with ileal biopsies obtained less frequently. Histopathology findings are noted frequently, but the majority are the result of or did not impact clinical care. There were no associations between abnormal histopathology or abnormal gross endoscopy findings with colonic manometry results.
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Affiliation(s)
- Derek G Armstrong
- From the Division of Pediatric Gastroenterology, Hepatology and Nutrition, Monroe Carell Jr. Children's Hospital at Vanderbilt University, Nashville, TN
| | - Bruno P Chumpitazi
- the Department of Pediatrics, Baylor College of Medicine, Houston, TX
- the Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Texas Children's Hospital, Houston, TX
- the Children's Nutrition Research Center, United States Department of Agriculture, Houston, TX
| | - Eric H Chiou
- the Department of Pediatrics, Baylor College of Medicine, Houston, TX
- the Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Texas Children's Hospital, Houston, TX
| | - Keshawadhana Balakrishnan
- the Department of Pediatrics, Baylor College of Medicine, Houston, TX
- the Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Texas Children's Hospital, Houston, TX
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Hagiwara SI, Abe N, Hosoi K, Hara T, Ishige T, Shimizu H, Mizuochi T, Kakiuchi T, Kunisaki R, Matsuoka R, Kondou H, Kakuta F, Nakayama Y, Kimura T, Maeyama T, Honma H, Hirano D, Saruta M, Yoshida T, Okayasu I, Etani Y. Utility of a rapid assay for prostaglandin E-major urinary metabolite as a biomarker in pediatric ulcerative colitis. Sci Rep 2023; 13:9898. [PMID: 37336963 DOI: 10.1038/s41598-023-37145-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 06/16/2023] [Indexed: 06/21/2023] Open
Abstract
Prostaglandin E-major urinary metabolite (PGE-MUM) is a urinary biomarker reflecting ulcerative colitis (UC) activity. This prospective observational study aimed to evaluate the usefulness of PGE-MUM via rapid chemiluminescent enzyme immunoassay in detecting endoscopic remission (ER) and histologic remission (HR) in pediatric UC (6-16 years) in comparison with fecal calprotectin (FCP). ER and HR were defined as Mayo endoscopic score (MES) of 0 and Matts' histological grades (Matts) of 1 or 2, respectively. A total of 104 UC and 39 functional gastrointestinal disorder (FGID) were analyzed. PGE-MUM levels were significantly higher in the UC group than in the FGID group (P < 0.001). FCP levels were significantly elevated in the group without ER and HR than in the group with ER and HR (P < 0.001 and P = 0.001), whereas PGE-MUM levels were significantly higher in the group without ER compared to the group with ER (P < 0.001). No significant differences were noted in the AUCs for PGE-MUM and FCP in detecting ER and HR. Although PGE-MUM was inferior to FCP for the detection of HR, it might have the potential for application as a biomarker of endoscopic activity in pediatric UC owing to its noninvasive and rapid method.
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Affiliation(s)
- Shin-Ichiro Hagiwara
- Department of Gastroenterology, Nutrition, and Endocrinology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan.
| | - Naoki Abe
- Division of Infectious Diseases and Immunology, Aichi Children's Health and Medical Center, Aichi, Japan
| | - Kenji Hosoi
- Department of Gastroenterology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Tomoko Hara
- Department of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama, Japan
| | - Takashi Ishige
- Department of Pediatrics, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hirotaka Shimizu
- Center for Pediatric Inflammatory Bowel Disease, Division of Gastroenterology, National Center for Child Health and Development, Tokyo, Japan
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tatsuki Mizuochi
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume, Japan
| | - Toshihiko Kakiuchi
- Department of Pediatrics, Faculty of Medicine, Saga University, Saga, Japan
| | - Reiko Kunisaki
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Ryo Matsuoka
- Department of Pediatrics, Fuji City Central Hospital, Fuji, Japan
| | - Hiroki Kondou
- Department of Pediatrics, Kindai University Nara Hospital, Nara, Japan
| | - Fumihiko Kakuta
- Department of General Pediatrics and Gastroenterology, Miyagi Children's Hospital, Sendai, Japan
| | - Yoshiko Nakayama
- Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takeshi Kimura
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takatoshi Maeyama
- Department of Gastroenterology, Nutrition, and Endocrinology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan
| | - Hitoshi Honma
- Department of Gastroenterology, Nutrition, and Endocrinology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan
| | - Daishi Hirano
- Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan
| | - Masayuki Saruta
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Tsutomu Yoshida
- Division of Molecular Pathology, Department of Comprehensive Medicine, Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, Kanagawa, Japan
| | - Isao Okayasu
- Kitasato University School of Medicine, Kanagawa, Japan
| | - Yuri Etani
- Department of Gastroenterology, Nutrition, and Endocrinology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan
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Huang JG, Tanpowpong P. Paediatric gastrointestinal endoscopy in the Asian-Pacific region: Recent advances in diagnostic and therapeutic techniques. World J Gastroenterol 2023; 29:2717-2732. [PMID: 37274071 PMCID: PMC10237107 DOI: 10.3748/wjg.v29.i18.2717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/12/2023] [Accepted: 04/14/2023] [Indexed: 05/11/2023] Open
Abstract
There has been a rapid expansion in the knowledge of paediatric gastroenterology over the recent decade, with a fast-growing repertoire of diagnostic techniques and management strategies for a wide spectrum of childhood gastrointestinal (GI) diseases. Paediatric GI endoscopy is a core competency every paediatric gastroenterologist should possess, and represents one of the most common procedures performed in children for both diagnostic and therapeutic purposes. Yet there remains a dearth of literature on the utility and outcomes of paediatric GI endoscopy in the Asia-Pacific region. Data on the diagnostic value of paediatric GI endoscopy would be an important aspect of discussion, with the emergence of inflammatory bowel disease (IBD) and eosinophilic GI disease as increasingly common endoscopic diagnoses. Time-based trends in paediatric GI endoscopy do point towards more IBD and gastroesophageal reflux disease-related complications being diagnosed, with a declining incidence of GI bleeding. However, the real-world diagnostic value of endoscopy in Asia must be contextualised to the region-specific prevalence of paediatric GI diseases. Helicobacter pylori infection, particularly that of multidrug-resistant strains, remains a highly prevalent problem in specific regions. Paediatric functional GI disorders still account for the majority of childhood GI complaints in most centres, hence the diagnostic yield of endoscopy should be critically evaluated in the absence of alarm symptoms. GI therapeutic endoscopy is also occasionally required for children with ingested foreign bodies, intestinal polyposis or oesophageal strictures requiring dilation. Endoscopic haemostasis is a potentially life-saving skill in cases of massive GI bleeding typically from varices or peptic ulcers. Advanced endoscopic techniques such as capsule endoscopy and balloon-assisted enteroscopy have found traction, particularly in East Asian centres, as invaluable diagnostic and therapeutic tools in the management of IBD, obscure GI bleeding and intestinal polyposis. State of the art endoscopic diagnostics and therapeutics, including the use of artificial intelligence-aided endoscopy algorithms, real-time confocal laser endomicroscopy and peroral endoscopic myotomy, are expected to gain more utility in paediatrics. As paediatric gastroenterology matures as a subspecialty in Asia, it is essential current paediatric endoscopists and future trainees adhere to minimum practice standards, and keep abreast of the evolving trends in the diagnostic and therapeutic value of endoscopy. This review discusses the available published literature on the utility of paediatric GI endoscopy in Asia Pacific, with the relevant clinical outcomes.
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Affiliation(s)
- James Guoxian Huang
- Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Khoo Teck Puat-National University Children’s Medical Institute, National University Health System, Singapore 119228, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine National University of Singapore, Singapore 119228, Singapore
| | - Pornthep Tanpowpong
- Department of Paediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
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Destro F, Salerno R, Calcaterra V, Ardizzone S, Meroni M, Roveri M, Pierucci UM, Zaja A, Rizzetto F, Campari A, Vertemati M, Milani P, Pelizzo G. Echo-Endoscopy Combined with Virtual Reality: A Whole Perspective of Laparoscopic Common Bile Duct Exploration in Children. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10040760. [PMID: 37190009 DOI: 10.3390/children10040760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/16/2023] [Accepted: 04/19/2023] [Indexed: 05/17/2023]
Abstract
Introduction: Endoscopic procedures are performed more frequently in children due to technological advances that can be safely performed in an adequate setting with a support of a multidisciplinary team. Pediatric indications for ERCP (endoscopic retrograde cholangiopancreatography) and EUS (endoscopic ultrasound) occur mainly due to congenital malformations. In a pediatric case series, we report the application of EUS combined with duodenoscopy, eventually associated with ERCP and minimally invasive surgery, highlighting the importance of defining a tailored dedicated management pathway for each patient. Patients and methods: A series of 12 patients, managed at our Center in the last three years, were evaluated, and their management was discussed. Results: EUS was performed in eight patients and permitted the differential diagnosis of duplication cysts and the visualization of the biliary tree and pancreatic anatomy. ERCP was attempted in five patients: in one case, it permitted the preservation of pancreatic tissue, postponing surgery and in three patients, it was technically unfeasible. MIS (minimally invasive surgery) was performed in seven patients, two with laparoscopic common bile duct exploration (LCBDE). Precise anatomical definition and the possibility of surgical simulation and team sharing were evaluated under VR HMD (Virtual Reality Head Mounted Display) in four cases. Conclusions: Exploration of the common bile duct in children differs from that of the adult population and combines echo-endoscopy and ERCP. The integrated use of minimally invasive surgery in the pediatric area is necessary for the whole management perspective in complex malformations and small patients. The introduction in the clinical practice of a preoperative study with Virtual Reality allows a better survey of the malformation and a tailored treatment.
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Affiliation(s)
- Francesca Destro
- Department of Pediatric Surgery, "Vittore Buzzi" Children's Hospital, 20154 Milan, Italy
| | - Raffaele Salerno
- Gastrointestinal and Digestive Endoscopy Unit, ASST Fatebenefratelli Sacco, 20157 Milan, Italy
| | - Valeria Calcaterra
- Department of Pediatrics, "Vittore Buzzi" Children's Hospital, 20154 Milan, Italy
- Department of Internal Medicine and Therapeutics, University of Pavia, 27100 Pavia, Italy
| | - Sandro Ardizzone
- Gastrointestinal and Digestive Endoscopy Unit, ASST Fatebenefratelli Sacco, 20157 Milan, Italy
| | - Milena Meroni
- Department of Pediatric Surgery, "Vittore Buzzi" Children's Hospital, 20154 Milan, Italy
| | - Margherita Roveri
- Department of Pediatric Surgery, "Vittore Buzzi" Children's Hospital, 20154 Milan, Italy
| | - Ugo Maria Pierucci
- Department of Pediatric Surgery, "Vittore Buzzi" Children's Hospital, 20154 Milan, Italy
| | - Alberta Zaja
- CIMaINa (Interdisciplinary Centre for Nanostructured Materials and Interfaces), University of Milano, 20133 Milan, Italy
| | - Francesco Rizzetto
- Postgraduate School of Diagnostic and Interventional Radiology, University of Milan, via Festa del Perdono 7, 20122 Milan, Italy
| | - Alessandro Campari
- Department of Pediatric Radiology, "Vittore Buzzi" Children's Hospital, 20154 Milan, Italy
| | - Maurizio Vertemati
- CIMaINa (Interdisciplinary Centre for Nanostructured Materials and Interfaces), University of Milano, 20133 Milan, Italy
| | - Paolo Milani
- CIMaINa (Interdisciplinary Centre for Nanostructured Materials and Interfaces), University of Milano, 20133 Milan, Italy
| | - Gloria Pelizzo
- Department of Biomedical and Clinical Science, University of Milano, 20157 Milan, Italy
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Mahoney LB, Lightdale JR. The Evolution of Sedation for Pediatric Gastrointestinal Endoscopy. Gastrointest Endosc Clin N Am 2023; 33:213-234. [PMID: 36948743 DOI: 10.1016/j.giec.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
Sedation for pediatric endoscopy has evolved from an endoscopist-administered component of procedures to an almost entirely anesthesiologist-supported endeavor. Nevertheless, there are no ideal endoscopist or anesthesiologist-administered sedation protocols, and wide practice variation exists in both models. Furthermore, sedation for pediatric endoscopy, whether administered by endoscopists or anesthesiologists, remains the highest risk to patient safety. This underscores the importance of both specialties identifying best sedation practices together that can safeguard patients while maximizing procedural efficiency and minimizing costs. In this review, the authors discuss specific levels of sedation for endoscopy and the risks and benefits of various regimens.
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Affiliation(s)
- Lisa B Mahoney
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Jenifer R Lightdale
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
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8
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Venkatesh RD, Leinwand K, Nguyen N. Pediatric Unsedated Transnasal Endoscopy. Gastrointest Endosc Clin N Am 2023; 33:309-321. [PMID: 36948748 DOI: 10.1016/j.giec.2022.10.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
Unsedated transnasal endoscopy (TNE) is a feasible, safe, and cost-effective procedure for pediatric patients. TNE provides direct visualization of the esophagus and enables acquisition of biopsy samples while eliminating the risks associated with sedation and anesthesia. TNE should be considered in the evaluation and monitoring of disorders of the upper gastrointestinal tract, particularly in diseases such as eosinophilic esophagitis that often require repeated endoscopy. Setting up a TNE program requires a thorough business plan as well as training of staff and endoscopists.
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Affiliation(s)
- Rajitha D Venkatesh
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, 700 Childrens Drive, Columbus, OH 43205, USA; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.
| | - Kristina Leinwand
- Section of Pediatric Gastroenterology, Hepatology and Nutrition, Northwest Permanente, Portland, OR, USA; Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Doernbecher Children's Hospital at Oregon Health and Science University, Portland, OR, USA
| | - Nathalie Nguyen
- Gastrointestinal Eosinophilic Diseases Program, Section of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital of Colorado, Digestive Health Institute, Children's Hospital Colorado, University of Colorado School of Medicine
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9
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Lee YM, Lee Y, Choi SY, Kim HJ, Hong SJ, Kang Y, Lee EH, Lee KJ, Choi Y, Yi DY, Kim S, Kang B. A Nationwide Survey on Gastrointestinal Endoscopy Practice Patterns among Pediatric Endoscopists in South Korea. Pediatr Gastroenterol Hepatol Nutr 2023; 26:79-87. [PMID: 36950059 PMCID: PMC10025574 DOI: 10.5223/pghn.2023.26.2.79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 06/11/2022] [Accepted: 08/23/2022] [Indexed: 03/24/2023] Open
Abstract
Purpose Gastrointestinal (GI) endoscopy is an important tool for diagnosing and treating GI diseases in children. This study aimed to analyze the current GI endoscopy practice patterns among South Korean pediatric endoscopists. Methods Twelve members of the Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition developed a questionnaire. The questionnaire was emailed to pediatric gastroenterologists attending general and tertiary hospitals in South Korea. Results The response rate was 86.7% (52/60), and 49 of the respondents (94.2%) were currently performing endoscopy. All respondents were performing esophagogastroduodenoscopy, and 43 (87.8%) were performing colonoscopy. Relatively rare procedures for children, such as double-balloon enteroscopy (DBE) (4.1%), endoscopic retrograde cholangiopancreatography (ERCP) (2.0%), and endoscopic ultrasound (EUS) (2.0%), were only performed by pediatric gastroenterologists at very few centers, but were performed by adult endoscopists in most of the centers; of all the respondents, 83.7% (41/49) performed emergency endoscopy. In most centers, the majority of the endoscopies were performed under sedation, with midazolam (100.0%) and ketamine (67.3%) as the most frequently used sedatives. Conclusion While most pediatric GI endoscopists perform common GI endoscopic procedures, rare procedures, such as DBE, ERCP, and EUS, are only performed by pediatric gastroenterologists at very few centers, and by adult GI endoscopists at most of the centers. For such rare procedures, close communication and cooperation with adult GI endoscopists are required.
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Affiliation(s)
- Yoo Min Lee
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Yoon Lee
- Department of Pediatrics, Korea University Anam Hospital, Seoul, Korea
| | - So Yoon Choi
- Department of Pediatrics, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Hyun Jin Kim
- Department of Pediatrics, Chungnam National University Hospital, Daejeon, Korea
| | - Suk Jin Hong
- Department of Pediatrics, Daegu Catholic University Medical Center, Daegu, Korea
| | - Yunkoo Kang
- Department of Pediatrics, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Eun Hye Lee
- Department of Pediatrics, Eulji General Hospital, Seoul, Korea
| | - Kyung Jae Lee
- Department of Pediatrics, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Youjin Choi
- Department of Pediatrics, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Dae Yong Yi
- Department of Pediatrics, Chungang University Medical Center, Seoul, Korea
| | - Seung Kim
- Department of Pediatrics, Yonsei University Severance Children’s Hospital, Seoul, Korea
| | - Ben Kang
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Korea
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Elhodhod MA, Hamdy AM, Fahmy PO, Awad YM. Diagnostic yield of esophagogastroduodenoscopy in upper gastrointestinal bleeding in pediatrics: a cross-sectional study at a tertiary center. EGYPTIAN PEDIATRIC ASSOCIATION GAZETTE 2023. [DOI: 10.1186/s43054-022-00153-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
Abstract
Background
Esophagogastroduodenoscopy (EGD) is currently considered the first-line diagnostic procedure of choice for upper gastrointestinal bleeding (UGIB); however, the etiology of bleeding remains unknown in a subset of patients. This study aimed to evaluate the diagnostic yield of EGD in UGIB in pediatrics and determine the clinical predictors for positive endoscopic diagnosis.
Methods
A cross-sectional study was conducted at the pediatrics endoscopy unit, Ain Shams University, Cairo, Egypt, where 100 children were included. They were referred for EGD due to overt UGIB in the form of hematemesis and/or melena. Full medical history, thorough physical examination, laboratory investigations, and endoscopic and histopathologic findings were documented.
Results
Forty-seven males and 54 females were included. Their ages ranged from 3 months to 15 years, with a median age of 4 years. Sixty-five percent presented with hematemesis only, 7% presented with melena only, and 28% presented with hematemesis and melena. An endoscopic diagnosis could be reached in 62% of cases, with Helicobacter pylori (H. pylori) gastritis (23%) and reflux esophagitis (11%) as the most common endoscopic diagnoses, with the former being the most common in children above 4 years and the latter for younger ones. Other diagnoses included non-specific gastritis (8%) and esophageal varices (4%). Presentation with melena only was a negative predictor to reach a diagnosis by EGD, while splenomegaly and thrombocytopenia were independent predictors of variceal bleeding.
Conclusion
EGD is the investigation of choice in children suffering from hematemesis especially in older age groups. Clinical and laboratory parameters might help in the prediction of the underlying etiology.
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Ruan W, Walsh CM, Pawa S, D'Souza SL, Banerjee P, Kothari S, McCreath GA, Fishman DS. Musculoskeletal injury and ergonomics in pediatric gastrointestinal endoscopic practice. Surg Endosc 2023; 37:248-254. [PMID: 35920909 DOI: 10.1007/s00464-022-09455-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 07/06/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND AIMS Endoscopy-related musculoskeletal injuries (ERI) are increasingly prevalent in adult endoscopists; however, there are no studies that have evaluated ERI and ergonomic practices among pediatric gastroenterologists and trainees. We aimed to examine the prevalence, nature, and impact of musculoskeletal injuries in pediatric endoscopic practice and assess attitudes towards ergonomic training needs. METHODS Pediatric gastroenterologists and trainees were surveyed to collect information on endoscopist and practice characteristics, the prevalence, nature, and impacts of ERI, ergonomics strategies employed in practice, previous ergonomics training, and perceptions of ergonomics training (elicited using a 1 (strongly disagree) to 5 (strongly agree) Likert scale). Responses were analyzed using descriptive statistics, and bivariate analyses were conducted to explore correlates of ERI. RESULTS Among 146 survey respondents, 50 (34.2%) were trainees and 96 (65.8%) were practicing endoscopists with a mean duration of endoscopic practice of 9.7 ± 9.4 years. Overall, 55.6% (n = 80/144) reported experiencing a musculoskeletal injury, with 34.7% (n = 50/144) reporting an injury attributable to endoscopy. Among those with ERI, the most common sites were the neck/upper back (44.0%), thumb (42.0%), hand/finger (38.0%), and lower back (36.0%). Women were more likely to experience ERI compared to men (43.4% vs. 23.4%; p = 0.013). Only 20.9% of participants had formal training in ergonomics. Respondents reported being motivated to implement practice changes to prevent ERI (4.41 ± 0.95) and perceived ergonomics training as important (4.37 ± 0.96). CONCLUSIONS Pediatric endoscopists, and particularly women, experience significant ERI; however, formal endoscopy ergonomics training is rare. Improved ergonomics training is needed for both practicing pediatric gastroenterologists and trainees.
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Affiliation(s)
- Wenly Ruan
- Section of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, 6701 Fannin Street, D1010.18, Houston, TX, 77030, USA.
| | - Catharine M Walsh
- Division of Gastroenterology, Hepatology, and Nutrition, and the Research and Learning Institutes, Hospital for Sick Children,, Department of Paediatrics and the Wilson Centre, University of Toronto, Toronto, ON, Canada
| | - Swati Pawa
- Section of Gastroenterology and Hepatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA.,Bill Hefner VA Healthcare System, Salisbury, NC, USA
| | | | - Promila Banerjee
- Loyola Stritch School of Medicine and Edward Hines Jr Veterans Administration Hospital, Hines, IL, USA
| | | | - Graham A McCreath
- The Hospital for Sick Children, SickKids Research Institute, Toronto, ON, Canada
| | - Douglas S Fishman
- Section of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, 6701 Fannin Street, D1010.18, Houston, TX, 77030, USA
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12
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Soria-Navarro B, Mendoza-Palomar N, Juampérez-Gomi J, Melendo S, Mercadal-Hally M, Lung M, Pérez MM, Quintero J, Soler-Palacin P. Infectious complications of non-surgical biliary tract manipulation in paediatric patients. Role of antibiotic prophylaxis. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2022; 40:539-545. [PMID: 36464471 DOI: 10.1016/j.eimce.2021.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 01/27/2021] [Indexed: 06/17/2023]
Abstract
BACKGROUND Infections related to non-surgical manipulation of the biliary tract (NSMBT) are common events despite periprocedural antibiotic prophylaxis (PAP). Since June 2017, our local protocol has indicated a 24-h regimen of intravenous piperacillin-tazobactam for this purpose. OBJECTIVE We aimed to describe the incidence and characteristics of NSMBT-related paediatric infections, define risk factors for their development, and analyse adherence to our PAP protocol. MATERIALS AND METHODS Epidemiological, clinical, and microbiological data were collected in consecutive NSMBT procedures performed in paediatric patients (<18 years) in our centre (2010-2019). RESULTS 113 procedures in 37 patients, median age 4 years (IQR 1-8), were included. Main underlying diseases were biliary atresia (32%) and cancer (14%). Sixty-eight percent had undergone liver transplant and 70% hepaticojejunostomy. In 44 procedures (39%), the intervention was performed during the course of infection and previously prescribed antibiotic treatment was maintained. In the other 69, PAP was specifically indicated for NSMBT; antibiotic adequacy increased from 35% to 100% after June 2017. In total, 32 NSMBT-related infections (28%) occurred, mainly in the first 24h post-procedure (72%); no deaths happened. Causative pathogens were Gram-negative rods (64%), Gram-positive cocci (28%), and Candida spp. (8%). Main related risk factors were hepaticojejunostomy, biliary obstruction, and liver transplant. CONCLUSIONS NSMBT in children entails a significant infection risk, even under antibiotic prophylaxis, being hepaticojejunostomy the main risk factor. Infectious complications mainly occurred immediately after the procedure. After establishing a PAP protocol, 100% of interventions received appropriate prophylaxis, decreasing antibiotic exposure time and potentially, the length of hospital stay.
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Affiliation(s)
- Beatriz Soria-Navarro
- Paediatric Infectious Diseases and Inmunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain
| | - Natalia Mendoza-Palomar
- Paediatric Infectious Diseases and Inmunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Paediatric Antibiotic Stewarship Program (PROA-NEN), Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Catalonia, Spain
| | - Javier Juampérez-Gomi
- Paediatric Hepatology and Liver Transplant Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Catalonia, Spain
| | - Susana Melendo
- Paediatric Infectious Diseases and Inmunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Paediatric Antibiotic Stewarship Program (PROA-NEN), Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Catalonia, Spain
| | - Maria Mercadal-Hally
- Paediatric Hepatology and Liver Transplant Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Catalonia, Spain
| | - Mayli Lung
- Microbiology Department, Hospital Universitari Vall d'Hebron, Institut de Recerca Vall d'Hebron, Autonomous University of Barcelona (UAB), Barcelona, Catalonia, Spain
| | - María Mercedes Pérez
- Interventional Radiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Catalonia, Spain
| | - Jesús Quintero
- Paediatric Hepatology and Liver Transplant Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Catalonia, Spain
| | - Pere Soler-Palacin
- Paediatric Infectious Diseases and Inmunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Paediatric Antibiotic Stewarship Program (PROA-NEN), Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Catalonia, Spain; Vall d'Hebron Barcelona Hospital Campus, Autonomous University of Barcelona (UAB), Barcelona, Catalonia, Spain.
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13
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Di Nardo G, Felici E, Zenzeri L, Mennini M, Evangelisti M, Parisi P, Massolo AC, Hassan C, Piccirillo M, Lucchini L, Furio S, Quatrale G, Strisciuglio C. Split-dose versus day-before regimen of sodium picosulfate plus magnesium citrate for bowel cleansing before colonoscopy in children: Randomized controlled trial. Dig Endosc 2022. [PMID: 36411968 DOI: 10.1111/den.14481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 11/20/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Polyethylene glycol (PEG) split-dose regimen is recommended as the option of choice for colon preparation before colonoscopy in children and adults. Sodium picosulfate plus magnesium citrate (SPMC) is equally effective but better tolerated than PEG for bowel preparation before colonoscopy in children. The aim of this study was to assess the superiority of SPMC split-dose regimen compared with SPMC day-before regimen for bowel cleansing before colonoscopy in children. METHODS This was a multicenter, randomized, single-blind study. Pediatric inpatients undergoing colonoscopy received SPMC either in the day-before dosing or in split dosing. Overall bowel cleansing was assessed using the Boston Bowel Preparation Scale (BBPS) and was rated as successful when BBPS was ≥6. Patient tolerability, acceptability, and compliance were recorded. RESULTS The rate of successful cleansing level was significantly higher in the split-dose group than in the day-before group (P < 0.001). The BBPS scores were significantly higher in the split-dose group than in the day-before group for the whole colon (P < 0.001), the right colon (P < 0.001) and transverse colon (P < 0.001). Patient acceptability was better in the split-dose group (P = 0.0003; P = 0.005). The percentage of children needing nasogastric tube placement was better in the split-dose group (P = 0.007). CONCLUSIONS The split-dose regimen of SPMC was superior to the day-before regimen in terms of successful colon cleansing and acceptability.
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Affiliation(s)
- Giovanni Di Nardo
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Enrico Felici
- Pediatric Unit, Children's Hospital, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Letizia Zenzeri
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy.,Pediatric Unit, Children's Hospital, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy.,Emergency Pediatric Department, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Maurizio Mennini
- Translational Research in Pediatric Specialities Area, Allergy Unit, "Bambino Gesù" Children's Hospital, IRCCS, Rome, Italy
| | - Melania Evangelisti
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Pasquale Parisi
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Anna Claudia Massolo
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus-Newborn-Infant, "Bambino Gesù" Children's Hospital, IRCCS, Rome, Italy
| | - Cesare Hassan
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Department of Gastroenterology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Marisa Piccirillo
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Livia Lucchini
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Silvia Furio
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Giovanna Quatrale
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Caterina Strisciuglio
- Department of Woman, Child and General and Specialistic Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
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Endoscopy in Infants With Gastrointestinal Bleeding Has Limited Diagnostic or Therapeutic Benefit. J Pediatr Gastroenterol Nutr 2022; 75:514-520. [PMID: 35848737 DOI: 10.1097/mpg.0000000000003566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVES Pediatric gastroenterologists are often consulted to perform diagnostic and therapeutic endoscopy in infants with gastrointestinal bleeding (GIB). The value of endoscopy and risk of complications in this population are not well characterized. We aimed to describe findings and outcomes of infants with GIB who undergo endoscopy. METHODS Retrospective, single-center, cohort study of hospitalized infants ≤12 months who underwent esophagogastroduodenoscopy (EGD) and/or colonoscopy/flexible sigmoidoscopy (COL) for GIB. Current procedural technology codes, international classification of diseases codes, and quality control logs identified infants. RESULTS Fifty-six infants were identified from 2008 to 2019 (51.8% female; mean age 161.6 days). Seven endoscopies identified sources of GIB: gastric ulcers, a duodenal ulcer, gastric angiodysplasia, esophageal varices, and an anastomotic ulcer. Three infants underwent therapeutic interventions of banding/sclerotherapy of esophageal varices and triamcinolone injection of an anastomotic ulcer. Six infants underwent abdominal surgery for GIB or suspected intestinal perforation after endoscopy, where a gastric perforation, jejunal perforation at an anastomotic stricture, necrotizing enterocolitis totalis with perforation, Meckel's diverticulum, and a duodenal ulcer were identified. No source of bleeding was identified surgically in 1 infant with GIB. Respiratory failure, use of vasopressors or octreotide, administration of blood products, and high blood urea nitrogen were associated with increased likelihood of requiring surgery ( P < 0.05 for all). CONCLUSIONS There was limited utility to performing endoscopy in infants ≤12 months old with clinical GIB. Endoscopy in these sick infants carries risk, and 3 infants in this series presented with a gastrointestinal (GI) perforation shortly after the procedure. These limitations and risks should influence clinical decision-making regarding endoscopy in infants with GIB.
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Wang S, Qiu X, Chen J, Mei H, Yan H, You J, Huang Y. Pediatric esophagogastroduodenoscopy in china: indications, diagnostic yield, and factors associated with findings. BMC Pediatr 2022; 22:522. [PMID: 36056317 PMCID: PMC9438071 DOI: 10.1186/s12887-022-03558-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 08/12/2022] [Indexed: 11/15/2022] Open
Abstract
Background Large-scale data on esophagogastroduodenoscopy (EGD) in China are scarce. This study aimed to assess the indications and diagnostic yield of EGD in children and the relationship between factors (such as age, sex, and indications) and diagnostic yield. Methods We performed a prospective cross-sectional observational study involving patients aged < 18 years who underwent diagnostic EGD. The study was conducted in five children’s hospitals, each in a different city. Demographic features, indications for endoscopy, and endoscopic and histopathological findings were collected. Univariable and multivariable ordinal logistic regression analyses of the relationship between the factors and diagnostic yield were performed. Results The study included 2268 patients (male/female ratio, 1.3:1) with a median age of 8.68 years. Among the 2268 children, the most frequent indications were abdominal pain in 1954 (86.2%), recurrent vomiting in 706 (31.1%), weight loss in 343 (15.1%), and others. The endoscopic yield was 62.5% and was the highest in patients with dysphagia (90.9%). The histologic yield was 30.4% and was the highest in patients with unexplained anemia (45.5%). On multivariable regression analysis, the endoscopic yield was associated with dysphagia, gastrointestinal (GI) bleeding, and recurrent vomiting, and the histologic yield was associated with age. Different groups of patients with abdominal pain had variable probabilities of abnormal endoscopic findings. Conclusions The most frequent indication of pediatric EGD is abdominal pain, with variable probabilities of abnormal endoscopic findings in different groups. Endoscopic yield and histologic yield are associated with certain alarming features. Trial registration The trial registration number (ClinicalTrials. gov): NCT03603093 (The study was registered on 27/07/2018).
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Affiliation(s)
- Shengnan Wang
- Department of Gastroenterology, Children's Hospital of Fudan University, Shanghai, China
| | - Xiaoxia Qiu
- Department of Gastroenterology, Children's Hospital of Fudan University, Shanghai, China
| | - Jingfang Chen
- Department of Gastroenterology, Children's Hospital of Fudan University Xiamen Branch, Xiamen, China
| | - Hong Mei
- Department of Gastroenterology, Wuhan Children's Hospital, Wuhan, China
| | - Haiyan Yan
- Department of Gastroenterology, Henan Children's Hospital (Zhengzhou Children's Hospital), Zhengzhou, China
| | - Jieyu You
- Department of Gastroenterology, Hunan Children's Hospital, Changsha, China
| | - Ying Huang
- Department of Gastroenterology, Children's Hospital of Fudan University, Shanghai, China.
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Perera KDR, Nawarathne NMM, Samarawickrama VT, Deraniyagala MP, Luxman WGE, Fernandopulle ANR. Endoscopic Retrograde Cholangiopancreatography in Children: Feasibility, Success, and Safety with Standard Adult Endoscopes and Accessories. Pediatr Gastroenterol Hepatol Nutr 2022; 25:406-412. [PMID: 36148288 PMCID: PMC9482827 DOI: 10.5223/pghn.2022.25.5.406] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 05/02/2022] [Accepted: 07/20/2022] [Indexed: 11/17/2022] Open
Abstract
PURPOSE The role of endoscopic retrograde cholangiopancreatography (ERCP) in the management of hepatobiliary and pancreatic diseases in the pediatric population was not well defined until recently. Our aim was to determine the feasibility, outcomes, and safety of ERCP in a local pediatric population, particularly using standard adult endoscopes and accessories. METHODS This retrospective study was conducted at the National Hospital of Sri Lanka. Pediatric patients (aged <16 years) who underwent ERCP from January 2015 to December 2020 were included in the study. Data, including patient demographics, indications for the procedure, technical details, and associated complications, were collected from the internal database and patient records maintained at the hospital. RESULTS The study included 62 patients who underwent a total of 98 ERCP procedures. All the procedures were performed by adult gastroenterologists using standard adult endoscopes and accessories. The mean age was 11.01±3.47 years. Pancreatic diseases were the major indications for most of the procedures (n=81, 82.7%), with chronic pancreatitis being the most common. Seventeen procedures (17.3%) were carried out for biliary diseases. Overall cannulation and technical success rates were 87.8% and 85.7%, respectively. Stent placement was the most common therapeutic intervention (n=66; 67.4%). Post-ERCP pancreatitis was the most common complication, occurring in eight patients (8.2%). CONCLUSION ERCP can be successfully and safely performed in pediatric populations using standard adult endoscopes and accessories with complications similar to those of adults. Adult ERCP services can be offered to most pediatric patients without additional costs of pediatric endoscopes and accessories.
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Burayzat S, Odeh M, Altamimi E, Al-Dweik S, El Wahab K, Alanasweh M, Al-Khraisat M, Barqawi M. Eesophagogastroduodenoscopy in paediatrics: does abiding by the international guidelines lead to appropriate management? A cross-sectional study. BMJ Open 2022; 12:e061489. [PMID: 36581988 PMCID: PMC9438205 DOI: 10.1136/bmjopen-2022-061489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
UNLABELLED Objectives Esophagogastroduodenoscopy (EGD) is one of the most practiced procedures in paediatric gastroenterology. As with all other procedures, it is guided and controlled by specific guidelines developed and approved internationally. The European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) and the American Society for Gastrointestinal Endoscopy (ASGE) guidelines are two of the most followed guidelines in paediatric gastroenterology. This study aimed to determine how optimal patient condition management is when following international paediatric gastroenterology guidelines and to correlate the appropriateness of EGD and other variables with positive or negative findings on EGD. DESIGN A cross-sectional retrospective cohort of all first-time diagnostic upper endoscopies was conducted between 1 January 2016 and 1 February 2020, in Prince Hamzah Hospital in Jordan. PARTICIPANTS Paediatric patients between 9 months and 14 years of age with indications for EGD. RESULTS Overall, 529 diagnostic EGDs were performed during the study period. Helicobacter pylori-associated gastritis was the most common final diagnosis in 247 patients (47%). Furthermore, 488 (92%) EGDs were deemed appropriate, while 41 (7.7%) were considered inappropriate. Finally, 74.0% of all biopsies performed had positive contributive findings. CONCLUSIONS Abiding by international guidelines in paediatric gastroenterology can optimise care for paediatric patients. General paediatricians are urged to follow guidelines rigorously when referring patients to minimise inappropriate procedures.
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Affiliation(s)
- Salma Burayzat
- Pediatrics, Faculty of Medicine, The Hashemite University, Zarqa, Jordan
| | - Mohanad Odeh
- Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, The Hashemite University, Zarqa, Jordan
| | - Eyad Altamimi
- Jordan University of Science and Technology, Irbid, Jordan
| | - Sarah Al-Dweik
- Faculty of Medicine, The Hashemite University, Zarqa, Jordan
| | - Khaled El Wahab
- Faculty of Medicine, The Hashemite University, Zarqa, Jordan
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Paediatric gastrointestinal endoscopy: Experience in Red Cross War Memorial Children’s Hospital, Cape Town, South Africa. SOUTH AFRICAN JOURNAL OF CHILD HEALTH 2022. [DOI: 10.7196/sajch.2022.v16i2.1816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background. Endoscopy is an important diagnostic and therapeutic mode of management in children with gastrointestinal disorders.
Objective. To determine the indications, endoscopic yields and impact of the service on the ongoing health and complications among children who underwent gastrointestinal endoscopy at Red Cross War Memorial Children’s Hospital, Cape Town.
Methods. A 10-year (2007 - 2016) retrospective study of children <18 years old who underwent gastrointestinal endoscopy was undertaken using relevant patients’ variables obtained from their hospital medical records. Data were analysed using Stata 13.1 (p<0.05).
Results. A total of 402 children underwent a total of 695 gastrointestinal endoscopic procedures: 592 (85.2%) were gastroscopies, 78 (11.2%) combined gastroscopies with colonoscopies and 25 (3.6%) colonoscopy-only procedures, respectively. The main diagnostic indications for gastroscopy, gastroscopy combined with colonoscopy and colonoscopy-only were chronic abdominal pain (n=49; 12.2%), suspected inflammatory bowel disease (n=30; 7.5%) and rectal bleeding (n=13; 52.0%) respectively. The most common therapeutic indication for gastroscopy was change of a percutaneous endoscopic gastrostomy (n=143; 35.6%) while for colonoscopy 6 (5.8%) had polypectomy. Abnormal histopathological results were made from both macroscopically normal- and abnormal-looking tissues, though with no statistically significant relationship.
Conclusion. Endoscopy offers diagnostic and therapeutic options in children. Positive histological findings were obtained in some cases where gastrointestinal mucosae appeared normal. There is need to obtain biopsies from both macroscopically normal- and abnormallooking gastrointestinal mucosae as positive histological findings could be made from them and hence improve diagnostic yield.
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Crawford E, Sabe R, Sferra TJ, Apperson-Hansen C, Khalili AS. Pediatric endoscopy across multiple clinical settings: Efficiency and adverse events. World J Gastrointest Endosc 2022; 14:367-375. [PMID: 35978713 PMCID: PMC9265253 DOI: 10.4253/wjge.v14.i6.367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 03/29/2022] [Accepted: 05/23/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Endoscopic procedures are becoming increasingly important for the diagnosis and treatment of gastrointestinal disorders during childhood, and have evolved from a more infrequent inpatient procedure in the operating room to a routine outpatient procedure conducted in multiple care settings. Demand for these procedures is rapidly increasing and thus there is a need to perform them in an efficient manner. However, there are little data comparing the efficiency of pediatric endoscopic procedures in diverse clinical environments. We hypothesized that there are significant differences in efficiency between settings.
AIM To compare the efficiency and examine adverse effects of pediatric endoscopic procedures across three clinical settings.
METHODS A retrospective chart review was conducted on 1623 cases of esophagogastroduodenoscopy (EGD) or combined EGD and colonoscopy performed between January 1, 2014 and May 31, 2018 by 6 experienced pediatric gastroenterologists in three different clinical settings, including a tertiary care hospital operating room, community hospital operating room, and free-standing pediatric ambulatory endoscopy center at a community hospital. The following strict guidelines were used to schedule patients at all three locations: age greater than 6 mo; American Society of Anesthesiologists class 1 or 2; normal craniofacial anatomy; no anticipated therapeutic intervention (e.g., foreign body retrieval, stricture dilation); and, no planned or anticipated hospitalization post-procedure. Data on demographics, times, admission rates, and adverse events were collected. Endoscopist time (elapsed time from the endoscopist entering the operating room or endoscopy suite to the next patient entering) and patient time (elapsed time from patient registration to that patient exiting the operating room or endoscopy suite) were calculated to assess efficiency.
RESULTS In total, 58% of the cases were performed in the tertiary care operating room. The median age of patients was 12 years and the male-to-female ratio was nearly equal across all locations. Endoscopist time at the tertiary care operating room was 12 min longer compared to the community operating room (63.3 ± 21.5 min vs 51.4 ± 18.9 min, P < 0.001) and 7 min longer compared to the endoscopy center (vs 56.6 ± 19.3 min, P < 0.001). Patient time at the tertiary care operating room was 11 min longer compared to the community operating room (133.2 ± 39.9 min vs 122.3 ± 39.5 min, P < 0.001) and 9 min longer compared to the endoscopy center (vs 124.9 ± 37.9 min; P < 0.001). When comparing endoscopist and patient times for EGD and EGD/colonoscopies among the three locations, endoscopist, and patient times were again shorter in the community hospital and endoscopy center compared to the tertiary care operating room. Adverse events from procedures occurred in 0.1% (n = 2) of cases performed in the tertiary care operating room, with 2.2% (n = 35) of cases from all locations having required an unplanned admission after the endoscopy for management of a primary GI disorder.
CONCLUSION Pediatric endoscopic procedures can be conducted more efficiently in select patients in a community operating room and endoscopy center compared to a tertiary care operating room.
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Affiliation(s)
- Erin Crawford
- Department of Pediatrics, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, OH 44113, United States
| | - Ramy Sabe
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, OH 44106, United States
| | - Thomas J Sferra
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, OH 44106, United States
| | - Carolyn Apperson-Hansen
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH 44106, United States
| | - Ali S Khalili
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, OH 44106, United States
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Evolution of International Pediatric Endoscopic Practice Changes During the Coronavirus Disease 2019 Pandemic. J Pediatr Gastroenterol Nutr 2022; 74:e138-e142. [PMID: 35185114 PMCID: PMC9172578 DOI: 10.1097/mpg.0000000000003416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES The coronavirus disease 2019 (COVID-19) pandemic has drastically altered endoscopic practices. We initially reported the international impact of COVID-19 on pediatric endoscopic practice. This follow-up study aimed to assess changes 7 months following the initial survey to delineate practice change patterns as the pandemic evolved. METHODS Pediatric gastroenterologists who responded to the initial survey were re-surveyed seven months later using Research Electronic Data Capture (REDCap). The survey recorded information on changes in pediatric endoscopic practice patterns, including COVID-19 screening and testing processes and personal protective equipment (PPE) utilization. Additionally, endoscopists' risk tolerance of COVID-19 transmission was evaluated. RESULTS Seventy-five unique institutions from 21 countries completed surveys from the 145 initial responses (51.7% response rate). Procedural volumes increased at most institutions (70.7%) and most were performing previously postponed cases (90.7%). Ninety-seven percent of institutions were performing pre-endoscopy screening with 78.7% testing all patients. Many institutions (34.7%) have performed procedures on COVID-19 positive patients. There was significantly less PPE reuse (P < 0.05) and fewer institutions recommending full PPE for all endoscopies (43.2% vs 59.2%, P = 0.013). Overall, pediatric endoscopists' risk tolerance of COVID-19 transmission is low. CONCLUSIONS This is the first survey to highlight the evolution of pediatric endoscopic practices related to the COVID-19 pandemic, underscoring the need for ongoing pandemic-related guidance for pediatric endoscopic practice.
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Dziechciarz P, Ruszczyński M, Horvath A. Sodium Picosulphate with Magnesium Citrate versus Polyethylene Glycol for Bowel Preparation in Children: A Systematic Review. Pediatr Gastroenterol Hepatol Nutr 2022; 25:228-239. [PMID: 35611374 PMCID: PMC9110845 DOI: 10.5223/pghn.2022.25.3.228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 03/07/2022] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To compare the effectiveness, tolerability, acceptability, and safety of sodium picosulphate with magnesium citrate (PS/Mg) and polyethylene glycol (PEG) in children (≤18 years) preparing for colonoscopy. METHODS Three electronic databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials) were searched till July 2020. Only randomized controlled trials (RCTs) were included. At least two authors independently selected studies and performed risk of bias assessment and data extraction. RESULTS Four RCTs (n=390), with overall good quality were included. A meta-analysis of two trials (n=224) found no statistically significant difference between the groups with respect to the proportion of patients who had excellent and good scores (≥6 points) according to the Boston Bowel Preparation Scale (relative risk: 0.99; 95% confidence interval [CI]: 0.90 to 1.08). Excellent and good scores were observed in both groups in approximately 90% of children. A meta-analysis of two other trials (n=150) showed no significant difference between the groups with respect to the mean total score for the Ottawa Bowel Preparation Scale (mean difference: 0.20; 95% CI: -0.74 to 1.14). Both regimens provided a comparable safety profile; however, PS/Mg was significantly superior to high volume PEG in terms of tolerability (abdominal pain, nausea, vomiting, bloating/flatulence/fullness) and acceptability (ease of formulation consumption, taste acceptance, need for nasogastric tube, compliance with full dose). CONCLUSION PS/Mg provides a quality and safety profile similar to PEG for bowel cleansing; however, it has better acceptance and tolerance in children preparing for colonoscopy.
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Affiliation(s)
- Piotr Dziechciarz
- Department of Pediatrics, The Medical University of Warsaw, Warsaw, Poland
| | - Marek Ruszczyński
- Department of Pediatrics, The Medical University of Warsaw, Warsaw, Poland
| | - Andrea Horvath
- Department of Pediatrics, The Medical University of Warsaw, Warsaw, Poland
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22
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Impact of COVID-19 pandemic on pediatric endoscopy: A multicenter study on behalf of the SIGENP Endoscopy Working Group. Dig Liver Dis 2022; 54:572-579. [PMID: 35361566 PMCID: PMC8904157 DOI: 10.1016/j.dld.2022.02.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 02/14/2022] [Accepted: 02/16/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Aim of the present report was to investigate the repercussions of COVID-19 pandemic on the procedural volumes and on the main indications of pediatric digestive endoscopy in Italy. METHODS An online survey was distributed at the beginning of December 2020 to Italian digestive endoscopy centers. Data were collected comparing two selected time intervals: the first from 1st of February 2019 to 30th June 2019 and the second from 1st February 2020 to 30th June 2020. RESULTS Responses to the survey came from 24 pediatric endoscopy Units. Globally, a reduction of 37.2% was observed between 2019 and 2020 periods with a significant decrease in median number of procedures (111 vs 57, p < 0.001). Both the median number of procedures performed for new diagnoses and those for follow-up purposes significantly decreased in 2020 (63 vs 36, p < 0.001 and 42 vs 21, p< 0.001, respectively). We reported a drastic reduction of procedures performed for suspected Celiac Disease and Functional Gastrointestinal Disorders (55.1% and 58.0%, respectively). Diagnostic endoscopies for suspected IBD decreased of 15.5%, whereas procedures for Mucosal Healing (MH) assessment reduced of 48.3%. CONCLUSIONS Our study provides real-world data outlining the meaningful impact of COVID-19 on pediatric endoscopy practice in Italy.
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23
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Lightdale JR, Walsh CM, Oliva S, Jacobson K, Huynh HQ, Homan M, Hojsak I, Gillett PM, Furlano RI, Fishman DS, Croft NM, Brill H, Bontems P, Amil-Dias J, Utterson EC, Tavares M, Rosh JR, Riley MR, Narula P, Mamula P, Mack DR, Liu QY, Lerner DG, Leibowitz IH, Otley AR, Kramer RE, Ambartsumyan L, Connan V, McCreath GA, Thomson MA. Pediatric Endoscopy Quality Improvement Network Quality Standards and Indicators for Pediatric Endoscopic Procedures: A Joint NASPGHAN/ESPGHAN Guideline. J Pediatr Gastroenterol Nutr 2022; 74:S30-S43. [PMID: 34402486 DOI: 10.1097/mpg.0000000000003264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION High-quality pediatric gastrointestinal procedures are performed when clinically indicated and defined by their successful performance by skilled providers in a safe, comfortable, child-oriented, and expeditious manner. The process of pediatric endoscopy begins when a plan to perform the procedure is first made and ends when all appropriate patient follow-up has occurred. Procedure-related standards and indicators developed to date for endoscopy in adults emphasize cancer screening and are thus unsuitable for pediatric medicine. METHODS With support from the North American and European Societies of Pediatric Gastroenterology Hepatology and Nutrition (NASPGHAN and ESPGHAN), an international working group of the Pediatric Endoscopy Quality Improvement Network (PEnQuIN) used the methodological strategy of the Appraisal of Guidelines for REsearch and Evaluation (AGREE) II instrument to develop standards and indicators relevant for assessing the quality of endoscopic procedures. Consensus was sought via an iterative online Delphi process and finalized at an in-person conference. The quality of evidence and strength of recommendations were rated according to the GRADE (Grading of Recommendation Assessment, Development, and Evaluation) approach. RESULTS The PEnQuIN working group achieved consensus on 14 standards for pediatric endoscopic procedures, as well as 30 indicators that can be used to identify high-quality procedures. These were subcategorized into three subdomains: Preprocedural (3 standards, 7 indicators), Intraprocedural (8 standards, 18 indicators), and Postprocedural (3 standards, 5 indicators). A minimum target for the key indicator, "rate of adequate bowel preparation," was set at ≥80%. DISCUSSION It is recommended that all facilities and individual providers performing pediatric endoscopy worldwide initiate and engage with the procedure-related standards and indicators developed by PEnQuIN to identify gaps in quality and drive improvement.
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Affiliation(s)
- Jenifer R Lightdale
- Department of Pediatrics, Division of Gastroenterology and Nutrition, UMass Memorial Children's Medical Center, University of Massachusetts Medical School, Worcester, MA, United States
| | - Catharine M Walsh
- Department of Paediatrics and the Wilson Centre, Division of Gastroenterology, Hepatology and Nutrition and the Research and Learning Institutes, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Salvatore Oliva
- Pediatric Gastroenterology and Liver Unit, Maternal and Child Health Department, Umberto I - University Hospital, Sapienza - University of Rome, Rome, Italy
| | - Kevan Jacobson
- Division of Gastroenterology, Hepatology and Nutrition, British Columbia's Children's Hospital and British Columbia Children's Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hien Q Huynh
- Pediatric Gastroenterology and Nutrition, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Matjaž Homan
- Department of Gastroenterology, Faculty of Medicine, Hepatology and Nutrition, University Children's Hospital, University of Ljubljana, Ljubljana, Slovenia
| | - Iva Hojsak
- Referral Center for Pediatric Gastroenterology and Nutrition, Children's Hospital Zagreb, University of Zagreb Medical School, Zagreb, University J.J. Strossmayer Medical School, Osijek, Croatia
| | - Peter M Gillett
- Paediatric Gastroenterology, Hepatology and Nutrition Department, Royal Hospital for Sick Children, Edinburgh, Scotland, United Kingdom
| | - Raoul I Furlano
- Pediatric Gastroenterology & Nutrition, Department of Pediatrics, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Douglas S Fishman
- Section of Pediatric Gastroenterology, Hepatology and Nutrition, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States
| | - Nicholas M Croft
- Blizard Institute, Barts and the London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - Herbert Brill
- Department of Pediatrics, Division of Gastroenterology & Nutrition, McMaster Children's Hospital, McMaster University, William Osler Health System, University of Toronto, Toronto, Ontario, Canada
| | - Patrick Bontems
- Division of Pediatrics, Department of Pediatric Gastroenterology, Queen Fabiola Children's University Hospital, ICBAS - Université Libre de Bruxelles, Brussels, Belgium
| | - Jorge Amil-Dias
- Pediatric Gastroenterology, Department of Pediatrics, Centro Hospitalar Universitário S. João, Porto, Portugal
| | - Elizabeth C Utterson
- Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Washington University School of Medicine/St. Louis Children's Hospital, St. Louis, MO, United States
| | - Marta Tavares
- Division of Pediatrics, Pediatric Gastroenterology Department, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, ICBAS - Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
| | - Joel R Rosh
- Division of Pediatric Gastroenterology, Department of Pediatrics, Goryeb Children's Hospital, Icahn School of Medicine at Mount Sinai, Morristown, NJ, United States
| | - Matthew R Riley
- Department of Pediatric Gastroenterology, Providence St. Vincent's Medical Center, Portland, OR, United States
| | - Priya Narula
- Department of Paediatric Gastroenterology, Sheffield Children's NHS Foundation Trust, Sheffield, South Yorkshire, United Kingdom
| | - Petar Mamula
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - David R Mack
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Quin Y Liu
- Division of Gastroenterology and Hepatology, Medicine and Pediatrics, Cedars-Sinai Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Diana G Lerner
- Division of Pediatrics, Pediatric Gastroenterology, Hepatology and Nutrition, Children's of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Ian H Leibowitz
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Children's National Medical Center, George Washington University, Washington, DC, United States
| | - Anthony R Otley
- Gastroenterology & Nutrition, Department of Pediatrics, IWK Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Robert E Kramer
- Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Children's Hospital of Colorado, University of Colorado, Aurora, CO, United States
| | - Lusine Ambartsumyan
- Department of Pediatrics, Division of Gastroenterology and Hepatology, Seattle Children's Hospital, University of Washington, Seattle, WA, United States
| | - Veronik Connan
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Graham A McCreath
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mike A Thomson
- Department of Paediatric Gastroenterology, Sheffield Children's NHS Foundation Trust, Sheffield, South Yorkshire, United Kingdom
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24
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Walsh CM, Lightdale JR, Fishman DS, Furlano RI, Mamula P, Gillett PM, Narula P, Hojsak I, Oliva S, Homan M, Riley MR, Huynh HQ, Rosh JR, Jacobson K, Tavares M, Leibowitz IH, Utterson EC, Croft NM, Mack DR, Brill H, Liu QY, Bontems P, Lerner DG, Amil-Dias J, Kramer RE, Otley AR, Ambartsumyan L, Connan V, McCreath GA, Thomson MA. Pediatric Endoscopy Quality Improvement Network Pediatric Endoscopy Reporting Elements: A Joint NASPGHAN/ESPGHAN Guideline. J Pediatr Gastroenterol Nutr 2022; 74:S53-S62. [PMID: 34402488 DOI: 10.1097/mpg.0000000000003266] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION High-quality procedure reports are a cornerstone of high-quality pediatric endoscopy as they ensure the clear communication of procedural events and outcomes, guide patient care and facilitate continuous quality improvement. The aim of this document is to outline standardized reporting elements that achieved international consensus as requirements for high-quality pediatric endoscopy procedure reports. METHODS With support from the North American and European Societies of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN and ESPGHAN), an international working group of the Pediatric Endoscopy Quality Improvement Network (PEnQuIN) used Delphi methodology to identify key elements that should be found in all pediatric endoscopy reports. Item reduction was attained through iterative rounds of anonymized online voting using a 6-point scale. Responses were analyzed after each round and items were excluded from subsequent rounds if ≤50% of panelists rated them as 5 ("agree moderately") or 6 ("agree strongly"). Reporting elements that ≥70% of panelists rated as "agree moderately" or "agree strongly" were considered to have achieved consensus. RESULTS Twenty-six PEnQuIN group members from 25 centers internationally rated 63 potential reporting elements that were generated from a systematic literature review and the Delphi panelists. The response rates were 100% for all three survey rounds. Thirty reporting elements reached consensus as essential for inclusion within a pediatric endoscopy report. DISCUSSION It is recommended that the PEnQuIN Reporting Elements for pediatric endoscopy be universally employed across all endoscopists, procedures and facilities as a foundational means of ensuring high-quality endoscopy services, while facilitating quality improvement activities in pediatric endoscopy.
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Affiliation(s)
- Catharine M Walsh
- 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
| | - Jenifer R Lightdale
- Division of Gastroenterology and Nutrition, UMass Memorial Children's Medical Center, Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, United States
| | - Douglas S Fishman
- Section of Pediatric Gastroenterology, Hepatology and Nutrition, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States
| | - Raoul I Furlano
- Pediatric Gastroenterology & Nutrition, Department of Pediatrics, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Petar Mamula
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Peter M Gillett
- Paediatric Gastroenterology, Hepatology and Nutrition Department, Royal Hospital for Sick Children, Edinburgh, Scotland, United Kingdom
| | - Priya Narula
- Department of Paediatric Gastroenterology, Sheffield Children's NHS Foundation Trust, Sheffield, South Yorkshire, United Kingdom
| | - Iva Hojsak
- Referral Center for Pediatric Gastroenterology and Nutrition, Children's Hospital Zagreb, University of Zagreb Medical School, Zagreb, University J.J. Strossmayer Medical School, Osijek, Croatia
| | - Salvatore Oliva
- Pediatric Gastroenterology and Liver Unit, Maternal and Child Health Department, Umberto I - University Hospital, Sapienza - University of Rome, Rome, Italy
| | - Matjaž Homan
- Department of Gastroenterology, Hepatology and Nutrition, University Children's Hospital, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Matthew R Riley
- Department of Pediatric Gastroenterology, Providence St. Vincent's Medical Center, Portland, OR, United States
| | - Hien Q Huynh
- Pediatric Gastroenterology and Nutrition, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Joel R Rosh
- Division of Pediatric Gastroenterology, Department of Pediatrics, Goryeb Children's Hospital, Icahn School of Medicine at Mount Sinai, Morristown, NJ, United States
| | - Kevan Jacobson
- Division of Gastroenterology, Hepatology and Nutrition, British Columbia's Children's Hospital and British Columbia Children's Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marta Tavares
- Division of Pediatrics, Pediatric Gastroenterology Department, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, ICBAS - Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
| | - Ian H Leibowitz
- Division of Gastroenterology, Hepatology and Nutrition, Children's National Medical Center, Department of Pediatrics, George Washington University, Washington, DC, United States
| | - Elizabeth C Utterson
- Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Washington University School of Medicine/St. Louis Children's Hospital, St. Louis, MO, United States
| | - Nicholas M Croft
- Blizard Institute, Barts and the London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - David R Mack
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Herbert Brill
- Division of Gastroenterology & Nutrition, Department of Pediatrics, McMaster Children's Hospital, McMaster University, Department of Paediatrics, William Osler Health System, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Quin Y Liu
- Division of Gastroenterology and Hepatology, Medicine and Pediatrics, Cedars-Sinai Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Patrick Bontems
- Division of Pediatrics, Department of Pediatric Gastroenterology, Queen Fabiola Children's University Hospital, ICBAS - Université Libre de Bruxelles, Brussels, Belgium
| | - Diana G Lerner
- Division of Pediatrics, Pediatric Gastroenterology, Hepatology and Nutrition, Children's of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Jorge Amil-Dias
- Pediatric Gastroenterology, Department of Pediatrics, Centro Hospitalar Universitário S. João, Porto, Portugal
| | - Robert E Kramer
- Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Children's Hospital of Colorado, University of Colorado, Aurora, CO, United States
| | - Anthony R Otley
- Gastroenterology & Nutrition, Department of Pediatrics, IWK Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Lusine Ambartsumyan
- Division of Gastroenterology and Hepatology, Seattle Children's Hospital, Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Veronik Connan
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Graham A McCreath
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mike A Thomson
- Department of Paediatric Gastroenterology, Sheffield Children's NHS Foundation Trust, Sheffield, South Yorkshire, United Kingdom
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25
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Walsh CM, Lightdale JR, Leibowitz IH, Lerner DG, Liu QY, Mack DR, Mamula P, Narula P, Oliva S, Riley MR, Rosh JR, Tavares M, Utterson EC, Amil-Dias J, Bontems P, Brill H, Croft NM, Fishman DS, Furlano RI, Gillett PM, Hojsak I, Homan M, Huynh HQ, Jacobson K, Ambartsumyan L, Otley AR, Kramer RE, McCreath GA, Connan V, Thomson MA. Pediatric Endoscopy Quality Improvement Network Quality Standards and Indicators for Pediatric Endoscopists and Endoscopists in Training: A Joint NASPGHAN/ESPGHAN Guideline. J Pediatr Gastroenterol Nutr 2022; 74:S44-S52. [PMID: 34402487 DOI: 10.1097/mpg.0000000000003265] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION High-quality pediatric endoscopy requires reliable performance of procedures by competent individual providers who consistently uphold all standards determined to assure optimal patient outcomes. Establishing consensus expectations for ongoing monitoring and assessment of individual pediatric endoscopists is a method for confirming the highest possible quality of care for such procedures worldwide. We aim to provide guidance to define and measure quality of endoscopic care for children. METHODS With support from the North American and European Societies of Pediatric Gastroenterology Hepatology and Nutrition (NASPGHAN and ESPGHAN), an international working group of the Pediatric Endoscopy Quality Improvement Network (PEnQuIN) used the methodological strategy of the Appraisal of Guidelines for REsearch and Evaluation (AGREE) II instrument to develop standards and indicators relevant for assessing the quality of endoscopists. Consensus was sought via an iterative online Delphi process and finalized at an in-person conference. The quality of evidence and strength of recommendations were rated according to the GRADE (Grading of Recommendation Assessment, Development, and Evaluation) approach. RESULTS The PEnQuIN working group achieved consensus on 6 standards that all providers who perform pediatric endoscopy should uphold and 2 standards for pediatric endoscopists in training, with 7 corresponding indicators that can be used to identify high-quality endoscopists. Additionally, these can inform continuous quality improvement at the provider level. Minimum targets for defining high-quality pediatric ileocolonoscopy were set for 2 key indicators: cecal intubation rate (≥90%) and terminal ileal intubation rate (≥85%). DISCUSSION It is recommended that all individual providers performing or training to perform pediatric endoscopy initiate and engage with these international endoscopist-related standards and indicators developed by PEnQuIN.
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Affiliation(s)
- Catharine M Walsh
- 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
| | - Jenifer R Lightdale
- Division of Gastroenterology and Nutrition, UMass Memorial Children's Medical Center, Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, United States
| | - Ian H Leibowitz
- Division of Gastroenterology, Hepatology and Nutrition, Children's National Medical Center, Department of Pediatrics, George Washington University, Washington, DC, United States
| | - Diana G Lerner
- Division of Pediatrics, Pediatric Gastroenterology, Hepatology and Nutrition, Children's of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Quin Y Liu
- Division of Gastroenterology and Hepatology, Medicine and Pediatrics, Cedars-Sinai Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - David R Mack
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Petar Mamula
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Priya Narula
- Department of Paediatric Gastroenterology, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, South Yorkshire, United Kingdom
| | - Salvatore Oliva
- Pediatric Gastroenterology and Liver Unit, Maternal and Child Health Department, Umberto I - University Hospital, Sapienza - University of Rome, Rome, Italy
| | - Matthew R Riley
- Department of Pediatric Gastroenterology, Providence St. Vincent's Medical Center, Portland, OR, United States
| | - Joel R Rosh
- Division of Pediatric Gastroenterology, Department of Pediatrics, Goryeb Children's Hospital, Icahn School of Medicine at Mount Sinai, Morristown, NJ, United States
| | - Marta Tavares
- Division of Pediatrics, Pediatric Gastroenterology Department, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, ICBAS - Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
| | - Elizabeth C Utterson
- Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Washington University School of Medicine/St. Louis Children's Hospital, St. Louis, MO, United States
| | - Jorge Amil-Dias
- Pediatric Gastroenterology, Department of Pediatrics, Centro Hospitalar Universitário S. João, Porto, Portugal
| | - Patrick Bontems
- Division of Pediatrics, Department of Pediatric Gastroenterology, Queen Fabiola Children's University Hospital, ICBAS - Université Libre de Bruxelles, Brussels, Belgium
| | - Herbert Brill
- Division of Gastroenterology & Nutrition, Department of Pediatrics, McMaster Children's Hospital, McMaster University, Department of Paediatrics, William Osler Health System, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Nicholas M Croft
- Blizard Institute, Barts and the London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - Douglas S Fishman
- Section of Pediatric Gastroenterology, Hepatology and Nutrition, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States
| | - Raoul I Furlano
- Pediatric Gastroenterology & Nutrition, Department of Pediatrics, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Peter M Gillett
- Paediatric Gastroenterology, Hepatology and Nutrition Department, Royal Hospital for Sick Children, Edinburgh, Scotland, United Kingdom
| | - Iva Hojsak
- Referral Center for Pediatric Gastroenterology and Nutrition, Children's Hospital Zagreb, University of Zagreb Medical School, Zagreb, University J.J. Strossmayer Medical School, Osijek, Croatia
| | - Matjaž Homan
- Department of Gastroenterology, Hepatology and Nutrition, University Children's Hospital, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Hien Q Huynh
- Pediatric Gastroenterology and Nutrition, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Kevan Jacobson
- Division of Gastroenterology, Hepatology and Nutrition, British Columbia's Children's Hospital and British Columbia Children's Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lusine Ambartsumyan
- Division of Gastroenterology and Hepatology, Seattle Children's Hospital, Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Anthony R Otley
- Gastroenterology & Nutrition, Department of Pediatrics, IWK Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Robert E Kramer
- Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Children's Hospital of Colorado, University of Colorado, Aurora, CO, United States
| | - Graham A McCreath
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Veronik Connan
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mike A Thomson
- Department of Paediatric Gastroenterology, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, South Yorkshire, United Kingdom
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Lightdale JR, Walsh CM, Narula P, Utterson EC, Tavares M, Rosh JR, Riley MR, Oliva S, Mamula P, Mack DR, Liu QY, Lerner DG, Leibowitz IH, Jacobson K, Huynh HQ, Homan M, Hojsak I, Gillett PM, Furlano RI, Fishman DS, Croft NM, Brill H, Bontems P, Amil-Dias J, Kramer RE, Ambartsumyan L, Otley AR, McCreath GA, Connan V, Thomson MA. Pediatric Endoscopy Quality Improvement Network Quality Standards and Indicators for Pediatric Endoscopy Facilities: A Joint NASPGHAN/ESPGHAN Guideline. J Pediatr Gastroenterol Nutr 2022; 74:S16-S29. [PMID: 34402485 DOI: 10.1097/mpg.0000000000003263] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION There is increasing international recognition of the impact of variability in endoscopy facilities on procedural quality and outcomes. There is also growing precedent for assessing the quality of endoscopy facilities at regional and national levels by using standardized rating scales to identify opportunities for improvement. METHODS With support from the North American and European Societies of Pediatric Gastroenterology Hepatology and Nutrition (NASPGHAN and ESPGHAN), an international working group of the Pediatric Endoscopy Quality Improvement Network (PEnQuIN) used the methodological strategy of the Appraisal of Guidelines for REsearch and Evaluation (AGREE) II instrument to develop standards and indicators relevant for assessing the quality of facilities where endoscopic care is provided to children. Consensus was reached via an iterative online Delphi process and subsequent in-person meeting. The quality of evidence and strength of recommendations were rated according to the GRADE (Grading of Recommendation Assessment, Development and Evaluation) approach. RESULTS The PEnQuIN working group achieved consensus on 27 standards for facilities supporting pediatric endoscopy, as well 10 indicators that can be used to identify high-quality endoscopic care in children. These standards were subcategorized into three subdomains: Quality of Clinical Operations (15 standards, 5 indicators); Patient and Caregiver Experience (9 standards, 5 indicators); and Workforce (3 standards). DISCUSSION The rigorous PEnQuIN process successfully yielded standards and indicators that can be used to universally guide and measure high-quality facilities for procedures around the world where endoscopy is performed in children. It also underscores the current paucity of evidence for pediatric endoscopic care processes, and the need for research into this clinical area.
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Affiliation(s)
- Jenifer R Lightdale
- Department of Pediatrics, Division of Gastroenterology and Nutrition, UMass Memorial Children's Medical Center, University of Massachusetts Medical School, Worcester, MA, United States
| | - Catharine M Walsh
- Department of Paediatrics and the Wilson Centre, Division of Gastroenterology, Hepatology and Nutrition and the Research and Learning Institutes, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Priya Narula
- Department of Paediatric Gastroenterology, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, South Yorkshire, United Kingdom
| | - Elizabeth C Utterson
- Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Washington University School of Medicine/St. Louis Children's Hospital, St. Louis, MO, United States
| | - Marta Tavares
- Pediatric Gastroenterology Department, Division of Pediatrics, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, ICBAS - Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
| | - Joel R Rosh
- Division of Pediatric Gastroenterology, Department of Pediatrics, Goryeb Children's Hospital, Icahn School of Medicine at Mount Sinai, Morristown, NJ, United States
| | - Matthew R Riley
- Department of Pediatric Gastroenterology, Providence St. Vincent's Medical Center, Portland, OR, United States
| | - Salvatore Oliva
- Pediatric Gastroenterology and Liver Unit, Maternal and Child Health Department, Umberto I - University Hospital, Sapienza - University of Rome, Rome, Italy
| | - Petar Mamula
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - David R Mack
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Quin Y Liu
- Division of Gastroenterology and Hepatology, Medicine and Pediatrics, Cedars-Sinai Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Diana G Lerner
- Division of Pediatrics, Pediatric Gastroenterology, Hepatology and Nutrition, Children's of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Ian H Leibowitz
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Children's National Medical Center, George Washington University, Washington, DC, United States
| | - Kevan Jacobson
- Division of Gastroenterology, Hepatology and Nutrition, British Columbia's Children's Hospital and British Columbia Children's Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hien Q Huynh
- Pediatric Gastroenterology and Nutrition, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Matjaž Homan
- Department of Gastroenterology, Hepatology and Nutrition, University Children's Hospital, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Iva Hojsak
- Referral Center for Pediatric Gastroenterology and Nutrition, Children's Hospital Zagreb, University of Zagreb Medical School, Zagreb, University J.J. Strossmayer Medical School, Osijek, Croatia
| | - Peter M Gillett
- Paediatric Gastroenterology, Hepatology and Nutrition Department, Royal Hospital for Sick Children, Edinburgh, Scotland, United Kingdom
| | - Raoul I Furlano
- Pediatric Gastroenterology & Nutrition, Department of Pediatrics, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Douglas S Fishman
- Section of Pediatric Gastroenterology, Hepatology and Nutrition, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States
| | - Nicholas M Croft
- Blizard Institute, Barts and the London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - Herbert Brill
- Division of Gastroenterology & Nutrition, Department of Pediatrics, McMaster Children's Hospital, McMaster University, Department of Paediatrics, William Osler Health System, Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Patrick Bontems
- Division of Pediatrics, Department of Pediatric Gastroenterology, Queen Fabiola Children's University Hospital, ICBAS - Université Libre de Bruxelles, Brussels, Belgium
| | - Jorge Amil-Dias
- Pediatric Gastroenterology, Department of Pediatrics, Centro Hospitalar Universitário S. João, Porto, Portugal
| | - Robert E Kramer
- Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Children's Hospital of Colorado, University of Colorado, Aurora, CO, United States
| | - Lusine Ambartsumyan
- Division of Gastroenterology and Hepatology, Seattle Children's Hospital, Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Anthony R Otley
- Gastroenterology & Nutrition, Department of Pediatrics, IWK Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Graham A McCreath
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Veronik Connan
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mike A Thomson
- Department of Paediatric Gastroenterology, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, South Yorkshire, United Kingdom
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Poddar U, Vadlapudi SS. What Is the Best for Colon Preparation: Single-Dose, Split-Dose or Add-ons to Polyethylene Glycol? Indian Pediatr 2022. [DOI: 10.1007/s13312-021-2389-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Gatto A, Capossela L, Ferretti S, Orlandi M, Pansini V, Curatola A, Chiaretti A. Foreign Body Ingestion in Children: Epidemiological, Clinical Features and Outcome in a Third Level Emergency Department. CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8121182. [PMID: 34943378 PMCID: PMC8700598 DOI: 10.3390/children8121182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/10/2021] [Accepted: 12/12/2021] [Indexed: 11/16/2022]
Abstract
Ingestion of foreign bodies is a frequent pediatric cause of access to the Emergency Department (ED). The aim of this study was to determine the epidemiological and clinical features of pediatric patients with a diagnosis of foreign body ingestion and to identify the factors associated with an urgent invasive procedure or hospitalization. This is a retrospective study conducted on a population of 286 pediatric patients (0-17 years) evaluated for foreign body ingestion at the Pediatric ED of "Fondazione Policlinico Universitario A. Gemelli, IRCSS" between October 2014 and June 2019. Data concerning age and gender, underlying diseases, type of foreign body, symptoms and signs, instrumental tests, specialist visits, treatment and outcome were analyzed. The majority of foreign bodies were coins (23%). Symptoms recurred in 50% of the foreign bodies with esophageal localization and between the 92 (32%) patients with symptoms the most common was vomiting (7%). X-rays was performed in 61% of patients. Among all patients, 253 patients (88.8%) had been discharged, 21 (7%) had been hospitalized, and four (1.4%) were sent to an outpatient facility. Besides, 17 (5.9%) patients had been transferred to the Observation Unit. Of the hospitalized patients (21 (7.3%)), clinical observation was performed for 57% and endoscopic procedure for 45%. Our data confirm that the ESPGHAN-ESGE guidelines application prevents interventions that are not necessary, avoiding diagnostic and therapeutic delays.
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Affiliation(s)
- Antonio Gatto
- Institute of Pediatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
- Correspondence:
| | - Lavinia Capossela
- Institute of Pediatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS—Università Cattolica Sacro Cuore, 00168 Rome, Italy; (L.C.); (S.F.); (M.O.); (A.C.); (A.C.)
| | - Serena Ferretti
- Institute of Pediatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS—Università Cattolica Sacro Cuore, 00168 Rome, Italy; (L.C.); (S.F.); (M.O.); (A.C.); (A.C.)
| | - Michela Orlandi
- Institute of Pediatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS—Università Cattolica Sacro Cuore, 00168 Rome, Italy; (L.C.); (S.F.); (M.O.); (A.C.); (A.C.)
| | - Valeria Pansini
- Institute of Pediatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Antonietta Curatola
- Institute of Pediatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS—Università Cattolica Sacro Cuore, 00168 Rome, Italy; (L.C.); (S.F.); (M.O.); (A.C.); (A.C.)
| | - Antonio Chiaretti
- Institute of Pediatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS—Università Cattolica Sacro Cuore, 00168 Rome, Italy; (L.C.); (S.F.); (M.O.); (A.C.); (A.C.)
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29
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Yuan C, Wang C, Wu J, Gao N, Li K, Li Y, Huang X, Huang W, Hu Z. Continuous infusion of lidocaine in pediatric colonoscopy: A randomized double-blind placebo-controlled study. Saudi J Gastroenterol 2021; 28:54-59. [PMID: 34806658 PMCID: PMC8919925 DOI: 10.4103/sjg.sjg_275_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Propofol is commonly used for providing procedural sedation during pediatric colonoscopy. Intravenous (i.v.) lidocaine can mitigate visceral pain and reduce propofol requirements during surgery. The aim of this study is to investigate the effect of i.v. lidocaine on perioperative propofol and sufentanil dose, pulse oxygen saturation, postoperative pain score, and recovery time during pediatric colonoscopy. METHODS We designed a randomized, double-blind, placebo-controlled study and enrolled 40 children aged from 3 to 10 years who underwent colonoscopy. After titration of propofol to achieve unconsciousness, the patients were given i.v. lidocaine (1.5 mg/kg later 2 mg/kg/hour) or the same volume of saline. Sedation was standardized and combined propofol with sufentanil. The primary outcome variables were intraoperative propofol and sufentanil requirements, and the number of oxygen desaturation episodes. Secondary outcome variables were recovery time after colonoscopy and post-colonoscopy pain. RESULTS Lidocaine infusion resulted in a significant reduction in propofol requirements: (median (quartile) 1.8 (1.5-2.0) vs. 3.0 (2.8-3.3) mg/kg respectively; P < 0.001) and sufentanil requirements: (median (quartile) 0.06 (0.05-0.08) vs. 0.1 (0.1-0.1) μg/kg respectively; P < 0.001). The number of subjects who experienced oxygen desaturation below 95% in the lidocaine group was also significantly less than that in the control group: 1 vs. 6 (P = 0.04). The mean (SD) recovery time was significantly shorter in the lidocaine group: (19.2 (2.6) vs. 13.3 (2.6) min respectively; P < 0.001). There was no significant difference in post-colonoscopy pain. CONCLUSION Continuous infusion of lidocaine resulted in reduction of propofol and sufentanil requirements, recovery time, and risk of hypoxemia during pediatric colonoscopy.
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Affiliation(s)
- Chao Yuan
- Department of Anesthesiology, Guangdong Women and Children Hospital, China
| | - Chengli Wang
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, China
| | - Jiayao Wu
- Department of Anesthesiology, Guangdong Women and Children Hospital, China
| | - Ningyang Gao
- Department of Anesthesiology, Guangdong Women and Children Hospital, China
| | - Kunwei Li
- Department of Anesthesiology, Guangdong Women and Children Hospital, China
| | - Yongle Li
- Department of Anesthesiology, Guangdong Women and Children Hospital, China
| | - Xizhao Huang
- Department of Anesthesiology, Guangdong Women and Children Hospital, China
| | - Wei Huang
- Department of Anesthesiology, Guangdong Women and Children Hospital, China
| | - Zurong Hu
- Department of Anesthesiology, Guangdong Women and Children Hospital, China,Address for correspondence: Dr. Zurong Hu, Department of Anesthesiology, Guangdong Women and Children Hospital, Guangzhou, China, No. 13 Guangyuan West Road, Guangzhou, 510010, China. E-mail:
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30
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Tagawa M, Morita A, Imagawa K, Mizokami Y. Endoscopic retrograde cholangiopancreatography and endoscopic ultrasound in children. Dig Endosc 2021; 33:1045-1058. [PMID: 33423305 DOI: 10.1111/den.13928] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 01/04/2021] [Accepted: 01/06/2021] [Indexed: 12/13/2022]
Abstract
Gastrointestinal endoscopy is fundamental to diagnostic and therapeutic procedures in pediatric gastroenterology. In the decades since endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) for hepatobiliary and pancreatic disease were introduced into clinical practice, there has been increasing interest in these procedures, and practice guidelines and position papers that clearly define the role of ERCP and EUS in children have been published. Based on the distinction of endoscopy between children and adults, this review focuses on the current state of ERCP and EUS procedures in children, including the types of endoscopes used in children, general anesthesia and radiation exposure, biliary and pancreatic indications, considerations of education and training for ERCP and EUS procedures in children, and expectations for development of endoscopes for children.
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Affiliation(s)
- Manabu Tagawa
- Department of Child Health, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Atsushi Morita
- Department of Child Health, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Kazuo Imagawa
- Department of Child Health, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Yuji Mizokami
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.,Endoscopic Center, University of Tsukuba Hospital, Ibaraki, Japan
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31
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Iwamoto M, Koshinaga T, Fujita E, Hanada M, Uehara S, Moriyama M. Ileal Dieulafoy lesion arose 15 years after partial small bowel resection for meconium obstruction of the neonate: a case report. BMC Pediatr 2021; 21:437. [PMID: 34620131 PMCID: PMC8494758 DOI: 10.1186/s12887-021-02914-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 09/23/2021] [Indexed: 11/18/2022] Open
Abstract
Background Anastomotic or perianastomotic ulcers present with symptoms such as chronic anaemia and occult bleeding as long-term complications of bowel resection performed in infancy. Case presentation Herein, we describe a 15-year-old girl with a history of surgery for meconium obstruction without mucoviscidosis in infancy who was hospitalized with chief complaints of presyncope and convulsions. Seven hours after admission, she developed melena and went into shock. An emergency laparotomy was performed, and a Dieulafoy lesion was detected near the site of ileal anastomosis from the surgery that had been performed during infancy. Conclusions Although overt massive lower gastrointestinal bleeding necessitating emergency care is rare in the long term after infant bowel resection, Dieulafoy lesions can cause serious bleeding, requiring rapid life-saving haemostatic procedures. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-021-02914-7.
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Affiliation(s)
- Maho Iwamoto
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Nihon University School of Medicine, 30-1 Oyaguchi-Kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Tsugumichi Koshinaga
- Department of Pediatric Surgery, Nihon University School of Medicine, 30-1 Oyaguchi-Kamicho, Itabashi-ku, Tokyo, 173-8610, Japan.
| | - Eri Fujita
- Department of Pediatric Surgery, Nihon University School of Medicine, 30-1 Oyaguchi-Kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Manabu Hanada
- Department of Pediatric Surgery, Nihon University School of Medicine, 30-1 Oyaguchi-Kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Shuichiro Uehara
- Department of Pediatric Surgery, Nihon University School of Medicine, 30-1 Oyaguchi-Kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Mitsuhiko Moriyama
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Nihon University School of Medicine, 30-1 Oyaguchi-Kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
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Fang S, Song Y, Liu Y, Wang L. Randomized clinical trial: efficacy and tolerability of two different split dose of low-volume polyethylene glycol electrolytes for bowel preparation before colonoscopy in hospitalized children. Pediatr Res 2021; 90:171-175. [PMID: 33106606 DOI: 10.1038/s41390-020-01216-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 05/23/2020] [Accepted: 07/21/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Eighty milliliter per kilogram of polyethylene glycol (PEG) for bowel preparation (BP) has been recommended, but the amount of liquid orally without nasogastric intubation is difficult to achieve. This study is to compare the efficacy and tolerability of two different low-volume PEG electrolyte solutions for BP in children. METHODS The randomized, double-blind, controlled trial enrolled 150 children aged 6-18 years undergoing colonoscopy in our center. Patients were randomly assigned to receive 60 ml/kg (PEG-ELS 60) or 40 ml/kg (PEG-ELS 40) of PEG electrolytes (PEG-ELS) 4000. The Boston Bowel Preparation Scale was used for bowel cleansing evaluation. Primary end point was overall colon cleansing. Tolerability was also evaluated. RESULTS PEG-ELS 40 and PEG-ELS 60 had similar efficacy in bowel cleansing for both whole colon and various colonic segments. The proportions of patients experiencing any adverse symptoms, or those who were willing to have BP repeated if necessary were similar in both groups. More patients considered the BP solution easy to take and be satisfied with the preparation in PEG-ELS 40 than PEG-ELS 60. CONCLUSIONS Low volume of PEG-ELS for BP has good efficacy in bowel cleansing. PEG-ELS with 40 ml/kg volume was not inferior to that of 60 ml/kg. IMPACT PEG-ELS 40 and PEG-ELS 60 had similar efficacy in bowel cleansing for whole and various colonic segments. The proportions of patients experiencing any adverse symptoms, or those who were willing to have BP repeated if necessary were similar in both groups. More patients considered BP solution easy to take and be satisfied with the preparation in PEG-ELS 40 than PEG-ELS 60. This study showed that low-volume PEG-ELS monotherapy was effective in bowel cleansing and explored a possibly feasible BP method for pediatrics in China that PEG-ELS 40 was comparable to PEG-ELS 60 regimen.
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Affiliation(s)
- Shengbo Fang
- Department of Pharmacy, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Yanqing Song
- Department of Pharmacy, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Yufei Liu
- Department of Pediatric Gastroenterology Unit, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Libo Wang
- Department of Pediatric Gastroenterology Unit, The First Hospital of Jilin University, Changchun, Jilin, China.
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Kudo T, Abukawa D, Nakayama Y, Segawa O, Uchida K, Jimbo K, Shimizu T. Nationwide survey of pediatric gastrointestinal endoscopy in Japan. J Gastroenterol Hepatol 2021; 36:1545-1549. [PMID: 33128271 DOI: 10.1111/jgh.15297] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/25/2020] [Accepted: 10/07/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIM The implementation rates of pediatric gastrointestinal endoscopy are increasing with advancements in the devices used and pediatricians' skills. As part of the Japan Pediatric Endoscopy Study Group, we aimed to investigate the rates of pediatric gastrointestinal endoscopy use and the associated adverse events through a nationwide survey. METHODS A questionnaire was sent to 630 institutions in Japan. The numbers of pediatric gastrointestinal endoscopy cases and adverse events occurring during endoscopy, from April 2011 to March 2016, were investigated. RESULTS Responses were obtained from 445 facilities. The total number of pediatric gastrointestinal endoscopies was 37 447 and that of endoscopic examinations was 32 219 (86.0%), with esophagogastroduodenoscopy accounting for 18 484 cases; ileal colonoscopy, 11 936; endoscopic retrograde cholangiopancreatography, 389; wireless capsule endoscopy, 897; and balloon-assisted enteroscopy, 513. The number of endoscopic treatments was 5228, followed by balloon dilatation (1703), foreign body removal (989), and polypectomy (822); 201 adverse events (0.54%) occurred, 79 of which presented during endoscopic examination (0.25%). Eight serious perforations were noted in 0.0054% and 0.025% of those undergoing esophagogastroduodenoscopy and colonoscopy, respectively. Overall, 122 adverse events (2.33%) occurred in association with endoscopic treatment. One case of cardiopulmonary arrest occurred because of accidental extubation. However, no deaths occurred. CONCLUSION Endoscopic examinations had a slightly higher adverse event rate, because of an increase in endoscopic retrograde cholangiopancreatography and small intestine enteroscopy, than that reported in previous studies, but the adverse event rate of endoscopic treatment did not increase.
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Affiliation(s)
- Takahiro Kudo
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan.,The Pediatric Gastrointestinal Endoscopy National Survey Working Group in Japanese Pediatric Endoscopy Research Group, Tokyo, Japan
| | - Daiki Abukawa
- Department of General Pediatrics and Gastroenterology, Miyagi Children's Hospital, Sendai, Japan.,The Pediatric Gastrointestinal Endoscopy National Survey Working Group in Japanese Pediatric Endoscopy Research Group, Tokyo, Japan
| | - Yoshiko Nakayama
- Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan.,The Pediatric Gastrointestinal Endoscopy National Survey Working Group in Japanese Pediatric Endoscopy Research Group, Tokyo, Japan
| | - Osamu Segawa
- Department of Pediatric Surgery, Tokyo Women's Medical University Hospital, Tokyo, Japan.,The Pediatric Gastrointestinal Endoscopy National Survey Working Group in Japanese Pediatric Endoscopy Research Group, Tokyo, Japan
| | - Keiichi Uchida
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Japan.,The Pediatric Gastrointestinal Endoscopy National Survey Working Group in Japanese Pediatric Endoscopy Research Group, Tokyo, Japan
| | - Keisuke Jimbo
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Toshiaki Shimizu
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan.,The Pediatric Gastrointestinal Endoscopy National Survey Working Group in Japanese Pediatric Endoscopy Research Group, Tokyo, Japan
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34
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Gastrointestinal endoscopy in children and adults: How do they differ? Dig Liver Dis 2021; 53:697-705. [PMID: 33692010 DOI: 10.1016/j.dld.2021.02.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 02/17/2021] [Accepted: 02/17/2021] [Indexed: 12/11/2022]
Abstract
Gastrointestinal endoscopy has grown dramatically over the past century, and with subsequent improvements in technology and anaesthesia, it has become a safe and useful tool for evaluation of GI pathology in children. There are substantial differences between paediatric and adult endoscopy beyond size, including: age-related patho-physiology and the different spectrum of diseases in children. Literature on endoscopic procedures in children is sparse but significant. The present review aims at describing the current knowledges on paediatric endoscopy practice and highlights the main areas of differences between paediatric and adult practice.
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35
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Efficacy of Two Regimens for Colon Cleansing Using Polyethylene Glycol 4000: A Randomized Open Label Trial. Indian Pediatr 2021. [DOI: 10.1007/s13312-021-2391-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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36
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Glass J, Alcalá HE, Tobin M. The Value of Obtaining Colonic Mucosal Biopsies of Grossly Normal Tissue in Pediatric Patients. J Pediatr Gastroenterol Nutr 2021; 72:677-682. [PMID: 33399330 DOI: 10.1097/mpg.0000000000003038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES Current practice during pediatric colonoscopy is to obtain random colonic biopsies, even from normal appearing tissue. The majority of literature published on colonic biopsy practice analyzes adults; however, limited data examines the pediatric population. The lack of standardization regarding tissue sampling during pediatric colonoscopy reinforces the necessity to study this question objectively. The aim of the present study was to assess the value of obtaining mucosal biopsies from grossly normal colonic tissue. METHODS A retrospective study was performed to examine the utility of obtaining colonic biopsies from normal appearing tissue. Subjects included patients who underwent colonoscopy during a 2-year period. Descriptive analyses and logistic regression models were used to determine endoscopic and histologic agreement and to characterize predictors of agreement. RESULTS The predictive value of agreement between normal appearing colonoscopies (n = 237) and histopathology was 81%. Excluding patients with inflammatory bowel disease (IBD) increased the predictive value to 85%. Two and a half percent of grossly normal colonoscopies had histological findings consistent with newly diagnosed IBD. Predictors of normal histology included abdominal pain (odds ratio [OR] 3.68, 95% CI 1.84-7.37), whereas a known diagnosis of IBD was predictive of abnormal histology (OR 0.22, 95% CI 0.08-0.67). Among the full sample, elevated inflammatory markers (OR 2.02, 95% CI 1.06-3.86) or fatigue (OR 2.60, 95% CI 1.13-5.94) were predictive of abnormal histology. CONCLUSIONS Results suggest that colonic biopsies may not need to be routinely obtained from all pediatric colonoscopies, particularly in those patients with complaints of abdominal pain. Biopsies should continue to be obtained from patients with a known diagnosis of IBD, elevated inflammatory markers, or fatigue. Further studies are needed to standardize protocols for biopsy practice in pediatric colonoscopy.
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Affiliation(s)
| | - Héctor E Alcalá
- Department of Family, Population, and Preventative Medicine, Program in Public Health
| | - Michelle Tobin
- Department of Pediatrics.,Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Stony Brook Children's Hospital, Stony Brook, NY
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Wong J, Taylor S, Lerner D. Role of sodium bicarbonate in the management of acute upper gastrointestinal bleeding. Endoscopy 2021; 53:E155-E156. [PMID: 32818996 DOI: 10.1055/a-1220-5957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Jonathan Wong
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Susan Taylor
- Division of Pediatric Anesthesia, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Diana Lerner
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Are biopsies always necessary in upper and lower gastrointestinal endoscopy in children? A retrospective 10-year analysis. Eur J Pediatr 2021; 180:1089-1098. [PMID: 33064219 DOI: 10.1007/s00431-020-03838-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 09/15/2020] [Accepted: 10/09/2020] [Indexed: 10/23/2022]
Abstract
Little attention has been given to the efficiency and validity of performing routine endoscopic biopsies in normal areas in children. This study aimed to investigate the need to perform routine biopsies in upper gastrointestinal endoscopy (UDE) and colonoscopy in normal areas by comparing macroscopy and histology. It was a 10-year retrospective analysis with the inclusion of 761 UDEs and 177 colonoscopies. Considering all segments, UDEs showed false-positive result rates of 73.11% and false-negative result rates of 14.34%. The histological results modified the initial management in 53.95% of patients. Considering all segments, colonoscopies showed false-positive result rates of 63.64% and false-negative result rates of 30.97%. The histological results modified the initial management in 34.45% of patients.Conclusion: If biopsies were obtained only in abnormal areas, the diagnosis would be lost in 53.95% of the patients in upper endoscopies and 85.7% of the colonoscopies, which justifies routine maintenance of biopsies in macroscopically normal areas in children. What is Known: • Little attention has been given to the efficiency and validity of endoscopic biopsies of normal areas during pediatric exams. • Only a few pediatric studies have correlated macroscopic and histological findings from endoscopic biopsies, and low sensitivity and specificity, as well as poor agreement, were reported. What is New: • Our study confirms the evidence that routine biopsies from macroscopically normal areas during upper and lower digestive endoscopies can lead to histopathological diagnoses and different medical management. • This is the first research on this topic in a Latin population, from a developing country, reassuring the results obtained in previous papers from other countries.
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Soria-Navarro B, Mendoza-Palomar N, Juampérez-Gomi J, Melendo S, Mercadal-Hally M, Lung M, Pérez MM, Quintero J, Soler-Palacin P. Infectious complications of non-surgical biliary tract manipulation in paediatric patients. Role of antibiotic prophylaxis. Enferm Infecc Microbiol Clin 2021; 40:S0213-005X(21)00045-8. [PMID: 33715879 DOI: 10.1016/j.eimc.2021.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 01/26/2021] [Accepted: 01/27/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Infections related to non-surgical manipulation of the biliary tract (NSMBT) are common events despite periprocedural antibiotic prophylaxis (PAP). Since June 2017, our local protocol has indicated a 24-h regimen of intravenous piperacillin-tazobactam for this purpose. OBJECTIVE We aimed to describe the incidence and characteristics of NSMBT-related paediatric infections, define risk factors for their development, and analyse adherence to our PAP protocol. MATERIALS AND METHODS Epidemiological, clinical, and microbiological data were collected in consecutive NSMBT procedures performed in paediatric patients (<18 years) in our centre (2010-2019). RESULTS 113 procedures in 37 patients, median age 4 years (IQR 1-8), were included. Main underlying diseases were biliary atresia (32%) and cancer (14%). Sixty-eight percent had undergone liver transplant and 70% hepaticojejunostomy. In 44 procedures (39%), the intervention was performed during the course of infection and previously prescribed antibiotic treatment was maintained. In the other 69, PAP was specifically indicated for NSMBT; antibiotic adequacy increased from 35% to 100% after June 2017. In total, 32 NSMBT-related infections (28%) occurred, mainly in the first 24h post-procedure (72%); no deaths happened. Causative pathogens were Gram-negative rods (64%), Gram-positive cocci (28%), and Candida spp. (8%). Main related risk factors were hepaticojejunostomy, biliary obstruction, and liver transplant. CONCLUSIONS NSMBT in children entails a significant infection risk, even under antibiotic prophylaxis, being hepaticojejunostomy the main risk factor. Infectious complications mainly occurred immediately after the procedure. After establishing a PAP protocol, 100% of interventions received appropriate prophylaxis, decreasing antibiotic exposure time and potentially, the length of hospital stay.
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Affiliation(s)
- Beatriz Soria-Navarro
- Paediatric Infectious Diseases and Inmunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain
| | - Natalia Mendoza-Palomar
- Paediatric Infectious Diseases and Inmunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Paediatric Antibiotic Stewarship Program (PROA-NEN), Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Catalonia, Spain
| | - Javier Juampérez-Gomi
- Paediatric Hepatology and Liver Transplant Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Catalonia, Spain
| | - Susana Melendo
- Paediatric Infectious Diseases and Inmunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Paediatric Antibiotic Stewarship Program (PROA-NEN), Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Catalonia, Spain
| | - Maria Mercadal-Hally
- Paediatric Hepatology and Liver Transplant Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Catalonia, Spain
| | - Mayli Lung
- Microbiology Department, Hospital Universitari Vall d'Hebron, Institut de Recerca Vall d'Hebron, Autonomous University of Barcelona (UAB), Barcelona, Catalonia, Spain
| | - María Mercedes Pérez
- Interventional Radiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Catalonia, Spain
| | - Jesús Quintero
- Paediatric Hepatology and Liver Transplant Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Catalonia, Spain
| | - Pere Soler-Palacin
- Paediatric Infectious Diseases and Inmunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Paediatric Antibiotic Stewarship Program (PROA-NEN), Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Catalonia, Spain; Vall d'Hebron Barcelona Hospital Campus, Autonomous University of Barcelona (UAB), Barcelona, Catalonia, Spain.
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Cox CB, Laborda T, Kynes JM, Hiremath G. Evolution in the Practice of Pediatric Endoscopy and Sedation. Front Pediatr 2021; 9:687635. [PMID: 34336742 PMCID: PMC8317208 DOI: 10.3389/fped.2021.687635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/18/2021] [Indexed: 12/15/2022] Open
Abstract
The fields of pediatric gastrointestinal endoscopy and sedation are critically important to the diagnosis and treatment of gastrointestinal (GI) disease in children. Since its inception in the 1970s, pediatric endoscopy has benefitted from tremendous technological innovation related to the design of the endoscope and its associated equipment. Not only that, but expertise among pediatric gastroenterologists has moved the field forward to include a full complement of diagnostic and therapeutic endoscopic procedures in children. In this review, we discuss the remarkable history of pediatric endoscopy and highlight current limitations and future advances in the practice and technology of pediatric endoscopy and sedation.
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Affiliation(s)
- Conrad B Cox
- Division of Pediatric Gastroenterology Hepatology, and Nutrition, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, United States
| | - Trevor Laborda
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Utah Primary Children's Hospital, Salt Lake City, UT, United States.,Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Baylor College of Medicine, Children's Hospital of San Antonio, San Antonio, TX, United States
| | - J Matthew Kynes
- Department of Anesthesiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, United States
| | - Girish Hiremath
- Division of Pediatric Gastroenterology Hepatology, and Nutrition, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, United States
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Hartjes KT, Dafonte TM, Lee AF, Lightdale JR. Variation in Pediatric Anesthesiologist Sedation Practices for Pediatric Gastrointestinal Endoscopy. Front Pediatr 2021; 9:709433. [PMID: 34458212 PMCID: PMC8385768 DOI: 10.3389/fped.2021.709433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 07/07/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Despite a worldwide shift toward anesthesiologist-administered sedation for gastrointestinal endoscopy in children, ideal sedation regimens remain unclear and best practices undefined. Aim: The aim of our study was to document variation in anesthesiologist-administered sedation for pediatric endoscopy. Outcomes of interest included coefficients of variation, procedural efficiency, as well as adverse events. Methods: IRB approval was obtained to review electronic health records of children undergoing routine endoscopy at our medical center during a recent calendar year. Descriptive and multivariate analyses were used to examine predictors of sedation practices. Results: 258 healthy children [2-21 years (median 15, (Q1-Q3 = 10-17)] underwent either upper and/or lower endoscopies with sedation administered by anesthesiologists (n = 21), using different sedation regimens (29) that ranged from a single drug administered to 6 sedatives in combination. Most patients did not undergo endotracheal tube intubation for the procedure (208, 81%), and received propofol (255, 89%) either alone or in combination with other sedatives. A total of 10 (3.8%) adverse events (9 sedation related) were documented to occur. The coefficient of variation (CV) for sedation times was high at 64.2%, with regression analysis suggesting 8% was unexplained by procedure time. Multivariable model suggested that longer procedure time (p < 0.0001), younger age (p < 0.0001), and use of endotracheal tube intubation (p = 0.02) were associated with longer sedation time. Discussion: We found great variation in anesthesiologist administered regimens for pediatric endoscopy at our institution that may be unwarranted, presenting may opportunities for minimizing patient risk, as well as for optimizing procedural efficiency.
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Affiliation(s)
- Kayla T Hartjes
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, MassGeneral Hospital for Children, Boston, MA, United States
| | - Tracey M Dafonte
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, MassGeneral Hospital for Children, Boston, MA, United States
| | - Austin F Lee
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Jenifer R Lightdale
- Division of Pediatric Gastroenterology and Nutrition, UMass Memorial Children's Medical Center, Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, United States
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Speidel AJ, Wölfle L, Mayer B, Posovszky C. Increase in foreign body and harmful substance ingestion and associated complications in children: a retrospective study of 1199 cases from 2005 to 2017. BMC Pediatr 2020; 20:560. [PMID: 33339520 PMCID: PMC7747382 DOI: 10.1186/s12887-020-02444-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 11/24/2020] [Indexed: 01/08/2023] Open
Abstract
Background Children with a history of caustic or foreign body ingestion (FBI) seem to be presenting more frequently to emergency departments. This study aims to elucidate the clinical presentation, diagnostic procedures, and complications associated with the ingestion of different object categories over a 13-year time period. Methods A structured retrospective data analysis of patients who presented between January 2005 and December 2017 to the University Medical Centre Ulm was performed. Patients up to 17 years of age with food impaction or foreign body or harmful substance ingestion were included by selection of the corresponding International Statistical Classification of Diseases and Related Health Problems (ICD10-GM) codes. Descriptive statistics, parametric or non-parametric tests, and linear regression analysis were performed. Result In total, 1199 patients were analysed; the mean age was 3.3 years (SD 3.12; range 7 days to 16 years), the male to female ratio was 1.15:1, and 194 (16.2%) were hospitalized. The number of patients seen annually increased from 66 in 2005 to 119 in 2017, with a rise in percentage of all emergency patients from 0.82% in 2010 to 1.34% in 2017. The majority of patients (n = 619) had no symptoms, and 244 out of 580 symptomatic patients complained of retching or vomiting. Most frequently, ingested objects were coins (18.8%). Radiopaque objects accounted for 47.6%, and sharp objects accounted for 10.5% of the ingested foreign bodies, both of which were significantly more often ingested by girls (p < 0.001 for both). Button battery ingestion was recorded for 63 patients with a significant annual increase (R2 = 0.57; β = 0.753; p = 0.003). The annual rate of complications also increased significantly (R2 = 0.42; β = 0.647; p = 0.017). Conclusion We found an alarming increase in the number of children who presented to our emergency department with FBI and associated complications. A standardized diagnostic and therapeutic approach may reduce and prevent serious complications. Further preventive measures within the home environment are needed to stop this trend.
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Affiliation(s)
- Arne Jorma Speidel
- Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Eythstr. 24, 89075, Ulm, Germany
| | - Lena Wölfle
- Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Eythstr. 24, 89075, Ulm, Germany
| | - Benjamin Mayer
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Carsten Posovszky
- Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Eythstr. 24, 89075, Ulm, Germany.
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Yabe K, Kouchi K, Takenouchi A, Matsuoka A, Kudou W, Nakata C. Current status and future challenges in the endoscopic management of non-variceal upper gastrointestinal bleeding in children. Pediatr Surg Int 2020; 36:1451-1458. [PMID: 33034717 DOI: 10.1007/s00383-020-04755-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/29/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE This study aimed to elucidate the characteristics of non-variceal upper gastrointestinal bleeding (NVUGIB) in children and the outcomes of endoscopic hemostasis (EH) performed by pediatric surgeons. METHODS We retrospectively reviewed the medical records of pediatric patients with NVUGIB who had undergone esophagogastroduodenoscopy (EGD) at our hospital, between December 2006 and March 2020. RESULTS Thirty-six patients were included. The most common endoscopic diagnosis was gastritis (28%), followed by gastric ulcer (25%) and duodenal ulcer (25%). Thirty patients (83%) had underlying diseases, including a recent viral infection (39%), followed by Helicobacter pylori infection (14%). Fourteen patients (39%) underwent EH, exhibiting a high initial rate of hemostasis (100%). This was achieved in 12/14 patients by clipping. One patient was treated using a combination of a hypersaline and epinephrine (HSE) injection and coagulation therapy, as the ulcer exceeded the width of the hemoclips. Rebleeding occurred in one patient (7.1%) initially treated with pure ethanol injections. The partial view of the pediatric duodenum prevented the placement of hemoclips; hence, the patient was treated using a combination of HSE and coagulation therapy. CONCLUSION Clipping, injection, and/or coagulation therapy can lead to high success rates for hemostasis, considering the anatomical characteristics in a pediatric population.
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Affiliation(s)
- Kiyoaki Yabe
- Department of Pediatric Surgery, Tokyo Women's Medical University Yachiyo Medical Center, 477-96 Owadasinden, Yachiyo-shi, Chiba, Japan.
| | - Katsunori Kouchi
- Department of Pediatric Surgery, Tokyo Women's Medical University Yachiyo Medical Center, 477-96 Owadasinden, Yachiyo-shi, Chiba, Japan
| | - Ayako Takenouchi
- Department of Pediatric Surgery, Tokyo Women's Medical University Yachiyo Medical Center, 477-96 Owadasinden, Yachiyo-shi, Chiba, Japan
| | - Aki Matsuoka
- Department of Pediatric Surgery, Tokyo Women's Medical University Yachiyo Medical Center, 477-96 Owadasinden, Yachiyo-shi, Chiba, Japan
| | - Wataru Kudou
- Department of Pediatric Surgery, Tokyo Women's Medical University Yachiyo Medical Center, 477-96 Owadasinden, Yachiyo-shi, Chiba, Japan
| | - Chikako Nakata
- Department of Pediatric Surgery, Tokyo Women's Medical University Yachiyo Medical Center, 477-96 Owadasinden, Yachiyo-shi, Chiba, Japan
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Chandwe K, Amadi B, Chipunza M, Zyambo M, Kelly P. Safety and Ethics in Endoscopic Studies in Children: Evidence From the BEECH Study in Zambia. J Trop Pediatr 2020; 67:5981785. [PMID: 33188430 PMCID: PMC7948385 DOI: 10.1093/tropej/fmaa074] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Environmental enteropathy is an example of a poorly-understood intestinal disorder affecting millions of children worldwide, characterized by malabsorption and stunting. Although there is increasing interest in non-invasive means of assessing intestinal structure and function, the potential value of intestinal biopsy for histology, immunostaining, RNA sequencing and epigenetic work means that endoscopic biopsy remains extremely valuable. We here report our experience in the BEECH (Biomarkers of Environmental Enteropathy in CHildren) study of stunting in Zambia, in the belief that it may help address the knowledge gap regarding the safety of endoscopic biopsy in vulnerable young children. METHODS We report our experience of safety in 119 children undergoing endoscopic biopsy in the BEECH study in Lusaka Children's Hospital, Lusaka, and discuss ethical considerations in this light. RESULTS Upper gastrointestinal endoscopy was performed on children with stunting (length-for-age z score -2 or less) not responsive to nutritional interventions. Conscious sedation was provided by anaesthetists. Of 119 children, 5 (4%) developed transient desaturation, but no serious adverse events were experienced; no clinical, demographic or anaesthetic characteristics were identified as predictive of desaturation. Two children derived clinically useful information from the endoscopy, one life-saving. Of 105 lactase tests, 59 (54%) showed hypolactasia. DISCUSSION Children with stunting underwent endoscopy safely, and some derived clinical benefit. Safety and the possibility of clinical benefit are usually felt to be preconditions for the ethical justification for endoscopy for research in children, and we believe that these conditions were met in this study.
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Affiliation(s)
- Kanta Chandwe
- Tropical Gastroenterology & Nutrition group, University of Zambia School of Medicine, 10101 Lusaka, Zambia,Correspondence: Kanta Chandwe, MMed. Paeds. Tropical Gastroenterology & Nutrition Group (TROPGAN), University of Zambia, School of Medicine. Lusaka 10101, ZAMBIA. Tel: +260-966-806-816. E-mail:
| | - Beatrice Amadi
- Tropical Gastroenterology & Nutrition group, University of Zambia School of Medicine, 10101 Lusaka, Zambia
| | - Miyoba Chipunza
- Tropical Gastroenterology & Nutrition group, University of Zambia School of Medicine, 10101 Lusaka, Zambia
| | - Masuzyo Zyambo
- Department of Anaesthesia, University of Zambia School of Medicine, 10101 Lusaka, Zambia
| | - Paul Kelly
- Tropical Gastroenterology & Nutrition group, University of Zambia School of Medicine, 10101 Lusaka, Zambia,Barts & The London School of Medicine, Queen Mary University of London, London E1 2AT, UK
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Abstract
Despite the increased global recognition of pediatric pancreatic diseases, there are limited data on the utility of sophisticated endoscopic procedures such as endoscopic ultrasonography (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) in their management. Promising results of recent studies have highlighted the emerging therapeutic utility of EUS and ERCP in children. With these latest developments in mind, this article reviews the current literature regarding diagnostic and therapeutic uses, benefits, limitations, and clinical outcomes of EUS and ERCP in pediatric pancreatology.
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Cuffari C, Ciciora SL, Ando M, Boules M, Croffie JM. Pediatric bowel preparation: Sodium picosulfate, magnesium oxide, citric acid vs polyethylene glycol, a randomized trial. World J Gastroenterol 2020; 26:6260-6269. [PMID: 33177798 PMCID: PMC7596638 DOI: 10.3748/wjg.v26.i40.6260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 09/16/2020] [Accepted: 09/25/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Bowel preparation in children can be challenging.
AIM To describe the efficacy, safety, and tolerability of sodium picosulfate, magnesium oxide, and citric acid (SPMC) bowel preparation in children.
METHODS Phase 3, randomized, assessor-blinded, multicenter study of low-volume, divided dose SPMC enrolled children 9-16 years undergoing elective colonoscopy. Participants 9-12 years were randomized 1:1:1 to SPMC ½ dose × 2, SPMC 1 dose × 2, or polyethylene glycol (PEG). Participants 13-16 years were randomized 1:1 to SPMC 1 dose × 2 or PEG. PEG-based bowel preparations were administered per local protocol. Primary efficacy endpoint for quality of bowel preparation was responders (rating of ‘excellent’ or ‘good’) by modified Aronchick Scale. Secondary efficacy endpoint was participant’s tolerability and satisfaction from a 7-item questionnaire. Safety assessments included adverse events (AEs) and laboratory evaluations.
RESULTS 78 participants were randomized, 48 were 9-12 years, 30 were 13-16 years. For the primary efficacy endpoint in 9-12 years, 50.0%, 87.5%, and 81.3% were responders for SPMC ½ dose × 2, SPMC 1 dose × 2, and PEG groups, respectively. Responder rates for 13-16 years were 81.3% for SPMC 1 dose × 2 and 85.7% for PEG. Overall, 43.8% of participants receiving SPMC 1 dose × 2 reported it was ‘very easy’ or ‘easy’ to drink, compared with 20.0% receiving PEG. Treatment-emergent AEs were reported by 45.5% of participants receiving SPMC 1 dose × 2 and 63.0% receiving PEG.
CONCLUSION SPMC was an efficacious and safe for bowel preparation in children 9-16 years, with comparable efficacy to PEG. Tolerability for SPMC was higher compared to PEG.
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Affiliation(s)
- Carmen Cuffari
- Department of Pediatrics, The Johns Hopkins School of Medicine, Baltimore, MD 21287, United States
| | - Steven L Ciciora
- Department of Pediatrics, The Ohio State University College of Medicine, Colombus, OH 43205, United States
| | - Masakazu Ando
- Department of Statistics, Ferring Pharmaceuticals Inc, Parsippany, NJ 07054, United States
| | - Mena Boules
- Department of Medical Affairs, Ferring Pharmaceuticals Inc, Parsippany, NJ 07054, United States
| | - Joseph M Croffie
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN 46202, United States
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Seitz ST, Rückel A, Siebenlist G, Besendörfer M, Schellerer VS. Case report: Tension pneumoperitoneum after diagnostic colonoscopy in an 11 y/o boy with Crohns disease. Int J Surg Case Rep 2020; 75:413-417. [PMID: 33002851 PMCID: PMC7527678 DOI: 10.1016/j.ijscr.2020.09.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 09/19/2020] [Indexed: 11/18/2022] Open
Abstract
Benign Pneumoperitoneum can rarely follow colonoscopy. Even benign Pneumoperitoneum can lead to tension pneumoperitoneum. Tension pneumoperitoneum is a critically dangerous adverse event. Risk of perforation and microperforation increases in chronically inflamed intestine. Apparently, even microperforations can lead to tension pneumoperitoneum.
Introduction Endoscopy is an established diagnostic and therapeutic tool in paediatric gastroenterology and a save method with rare complications. Presentation of case We present the case of an 11-year-old Caucasian boy with a long history of inflammatory bowel disease. Three years prior an ileostomy was created and is still in position. After diagnostic panendoscopy (colonoscopy, gastroscopy, endoscopy of small intestine via ileostomy) the patient showed progressive abdominal distension and pain. After diagnosis of tension pneumoperitoneum by radiological proof of massive intraabdominal air and altered vital signs, we initiated emergency laparotomy. Surgical intervention ruled out a free gastrointestinal perforation as well as peritonitis. There was a gaseous insufflation of the mesenteric tissue of the sigmoid and upper rectum most likely according to microperforations to the mesentery. Due to the pre-existing ileostomy, we took no further surgical action. The abdomen was lavaged and drains inserted. Upon further conservative treatment with intravenous antibiotics, the patient showed quick recovery and was discharged on postoperative day 6. Discussion With an incidence of 0.01%, perforation after diagnostic colonoscopy in children is very uncommon. The zone most frequently affected is the sigmoid colon due to direct penetration or indirect force due to flexure, or insufflation. Even without macroscopic perforation, the development of a tension pneumoperitoneum seems to be possible. Conclusion Even though Colonoscopy in children is a safe tool, the treating physician must never underestimate the risks of such an intervention. Especially chronically altered intestine as in long-time persisting chronic inflammatory bowel disease demand special care and intensive observation of the patient after intervention.
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Affiliation(s)
- Sigurd T Seitz
- Department of Pediatric Surgery, University Medical Center Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.
| | - Aline Rückel
- Department of Pediatrics and Adolescent Medicine, University Medical Center Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Gregor Siebenlist
- Department of Pediatrics and Adolescent Medicine, University Medical Center Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Manuel Besendörfer
- Department of Pediatric Surgery, University Medical Center Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Vera S Schellerer
- Department of Pediatric Surgery, University Medical Center Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
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de Oliveira Junior WE, Felix TF, Pires GDV, Lapa RML, Severino FE, Terra SA, Lourenção PLTDA, Dos Reis PP, Ortolan EVP. MicroRNA expression profiles in the esophagus of children with caustic stenosis: A pathway towards esophageal cancer? J Pediatr Surg 2020; 55:2144-2149. [PMID: 32111433 DOI: 10.1016/j.jpedsurg.2020.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 12/31/2019] [Accepted: 02/11/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Eighty percent of caustic ingestions occur in children and esophageal neoplasms may develop as a late complication of such injury. The identification of biomarkers is a promising strategy to improve early diagnosis of esophageal cancer or caustic lesions that are at an increased risk of progression. STUDY DESIGN/AIMS This study aimed at identifying global microRNA (miRNA) expression changes in esophageal mucosa from children with caustic stenosis. The study included 27 biopsy samples from 15 patients. Samples were divided into two groups, according to the time elapsed after injury (N = 15 in Group A, with less than five years of follow-up and N = 12 in Group B, with more than five years of follow-up). miRNA expression profiles were determined in each lesion, compared with normal esophageal tissues from control group. We used the TaqMan Human MicroRNA Arrays (Thermo Fisher) platform. Furthermore, bioinformatic algorithms were used to identify miRNA target genes and biological pathways including miRNAs and their target genes potentially associated with esophageal disease. RESULTS Thirteen miRNAs were significantly deregulated (9 over- and 4 underexpressed) in patients from Group A. In patients from Group B, two miRNAs were over- and two were underexpressed. Of note, miR-374 and miR-574 were deregulated in Group B patients and have been linked to esophageal tumorigenesis. We identified signal transduction and transcription factor networks with genes strongly related to development and progression of esophageal cancer. CONCLUSION miRNAs identified here contribute to a better understanding of pathways associated with malignant transformation from caustic stenosis to neoplastic lesions. This study may serve as a basis for validation of miRNAs, including miR-374 and miR-574, as potential biomarkers of early cancer detection.
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Affiliation(s)
- Wilson Elias de Oliveira Junior
- Division of Pediatric Surgery-Department of Surgery and Orthopedics, Faculty of Medicine, São Paulo State University (UNESP), Botucatu, SP, Brazil; Department of Pediatric Surgery, Barretos Children's Cancer Hospital from Barretos Cancer Center, Barretos, SP, Brazil.
| | - Tainara Francini Felix
- Department of Surgery and Orthopedics, Faculty of Medicine, São Paulo State University (UNESP), Botucatu, SP, Brazil; Experimental Research Unity (UNIPEX), Faculty of Medicine, São Paulo State University (UNESP), Botucatu, SP, Brazil
| | | | - Rainer Marco Lopez Lapa
- Experimental Research Unity (UNIPEX), Faculty of Medicine, São Paulo State University (UNESP), Botucatu, SP, Brazil; Department of Genetics, Institute of Biosciences, São Paulo State University (UNESP), Botucatu, SP, Brazil
| | - Fábio Eduardo Severino
- Department of Surgery and Orthopedics, Faculty of Medicine, São Paulo State University (UNESP), Botucatu, SP, Brazil; Experimental Research Unity (UNIPEX), Faculty of Medicine, São Paulo State University (UNESP), Botucatu, SP, Brazil
| | - Simone Antunes Terra
- Department of Pathology, Faculty of Medicine, São Paulo State University (UNESP), Botucatu, SP, Brazil
| | - Pedro Luiz Toledo de Arruda Lourenção
- Division of Pediatric Surgery-Department of Surgery and Orthopedics, Faculty of Medicine, São Paulo State University (UNESP), Botucatu, SP, Brazil; Department of Surgery and Orthopedics, Faculty of Medicine, São Paulo State University (UNESP), Botucatu, SP, Brazil
| | - Patricia Pintor Dos Reis
- Department of Surgery and Orthopedics, Faculty of Medicine, São Paulo State University (UNESP), Botucatu, SP, Brazil; Experimental Research Unity (UNIPEX), Faculty of Medicine, São Paulo State University (UNESP), Botucatu, SP, Brazil
| | - Erika Veruska Paiva Ortolan
- Division of Pediatric Surgery-Department of Surgery and Orthopedics, Faculty of Medicine, São Paulo State University (UNESP), Botucatu, SP, Brazil; Department of Surgery and Orthopedics, Faculty of Medicine, São Paulo State University (UNESP), Botucatu, SP, Brazil
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Setiawan CT, Landrigan-Ossar M. Pediatric Anesthesia Outside the Operating Room: Case Management. Anesthesiol Clin 2020; 38:587-604. [PMID: 32792186 DOI: 10.1016/j.anclin.2020.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Anesthesiology teams care for children in diverse locations, including diagnostic and interventional radiology, gastroenterology and pulmonary endoscopy suites, radiation oncology units, and cardiac catheterization laboratories. To provide safe, high-quality care, anesthesiologists working in these environments must understand the unique environmental and perioperative considerations and risks involved with each remote location and patient population. Once these variables are addressed, anesthesia and procedural teams can coordinate to ensure that patients and families receive the same high-quality care that they have come to expect in the operating room. This article also describes some of the considerations for anesthetic care in outfield locations.
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Affiliation(s)
- Christopher Tan Setiawan
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Anesthesiology, Children's Medical Center, 1935 Medical District Drive, Dallas, TX 75235, USA
| | - Mary Landrigan-Ossar
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Harvard Medical School, Boston, MA, USA.
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Wani MA, Zargar SA, Yatoo GN, Haq I, Shah A, Sodhi JS, Gulzar GM, Khan M. Endoscopic Yield, Appropriateness, and Complications of Pediatric Upper Gastrointestinal Endoscopy in an Adult Suite: A Retrospective Study of 822 Children. Clin Endosc 2020; 53:436-442. [PMID: 32252499 PMCID: PMC7403021 DOI: 10.5946/ce.2019.118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 10/17/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND/AIMS This study aimed to study the endoscopic yield, appropriateness, and complications of pediatric endoscopy performed by adult gastroenterologists in an adult endoscopic suite. METHODS This a retrospective study in which records of all the patients less than 18 years of age who underwent endoscopy in the last 5 years were studied. The indications of endoscopy in children were categorized as appropriate or inappropriate per the latest guidelines by American Society for Gastrointestinal Endoscopy and North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. Positive endoscopic yield was defined as the presence of any abnormality on endoscopy. RESULTS Among the total of 822 children (age <18 years), the most common indications were variceal surveillance/eradication in 157 (19.1%), followed by dyspepsia in 143 (17.4%), upper gastrointestinal (UGI) bleeding in 136 (16.5%), recurrent abdominal pain in 94 (11.4%), unexplained anemia in 74 (9%), recurrent vomiting in 50 (6.08%), chronic refractory gastroesophageal reflux disease in 34 (4.1%) and others; 780 out of 822 endoscopic procedures (94.9%) done in children were appropriate as per the guidelines. The endoscopic yield was 45.8%, highest in patients with UGI bleeding (71.3%), followed by variceal surveillance (54.8%), recurrent vomiting (38%), dyspepsia (37.8%), and recurrent abdominal pain (36%). Minor adverse events occurred in 7.3% of children. CONCLUSION Pediatric endoscopy performed by an experienced adult gastroenterologist may be acceptable if done in cooperation with a pediatrician.
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Affiliation(s)
- Manzoor Ahmad Wani
- Department of Gastroenterology and Hepatology, Jawahar Lal Nehru Memorial Hospital (JLNMH), Srinagar, India
| | - Showkat Ali Zargar
- Department of Gastroenterology and Hepatology, Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, India
| | - Ghulam Nabi Yatoo
- Department of Gastroenterology and Hepatology, Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, India
| | - Inaamul Haq
- Department of Community Medicine, Government Medical College (GMC) Srinagar, Srinagar, India
| | - Altaf Shah
- Department of Gastroenterology and Hepatology, Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, India
| | - Jaswinder Singh Sodhi
- Department of Gastroenterology and Hepatology, Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, India
| | - Ghulam Mohammad Gulzar
- Department of Gastroenterology and Hepatology, Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, India
| | - Mushtaq Khan
- Department of Gastroenterology and Hepatology, Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, India
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