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Pediatric Endoscopy Practice Patterns in the United States, Canada and Mexico.

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Pediatric Endoscopy Practice Patterns in the United States, Canada and Mexico.

J Pediatr Gastroenterol Nutr. 2019 Feb 14;:

Authors: Barakat MT, Triadafilopoulos G, Berquist WE

Abstract
BACKGROUND & AIMS: Endoscopic procedures are important for diagnosis and management of many gastrointestinal, liver and biliary conditions in children. Therapeutic endoscopy procedures, including ERCP, are performed less frequently in children relative to adults. However, a formal study to evaluate institutional volumes and practice patterns for advanced therapeutic pediatric endoscopy procedures has not been previously undertaken.
METHODS: A self-administered 16-question (5-minute) online survey assessing practice patterns for performance of pediatric endoscopy procedures was distributed to all registered North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) programs. Results were analyzed using descriptive statistics and thematic analysis of free-text comments.
RESULTS: Respondents from 82.9% of NASPGHAN centers completed this survey. Responses revealed that EGD/colonoscopy are performed at the vast majority of centers (>90%), with most performing >50/year. Therapeutic endoscopy procedures are performed less frequently in the pediatric population, with 18.97% reporting that ERCP is not performed at their institution. Where ERCP is performed, 91.38% reported <25/year. EUS is not performed at over half (53.33%) of institutions. 71.67% of respondents do not believe their institution's current arrangement for performing pediatric therapeutic endoscopy procedures is adequate.
CONCLUSIONS: Although the range of endoscopic procedures performed in children parallels that performed in adults, there are notable differences in pediatric and adult gastroenterologists' endoscopy training and procedure volumes. Our results and respondent comments suggest that pediatric patients would benefit from a partnership between pediatric and adult gastroenterologists, with adult gastroenterologists performing more complex therapeutic endoscopic procedures.

PMID: 30789864 [PubMed - as supplied by publisher]

Pediatric Endoscopy and High Risk Patients: A Clinical Report from the NASPGHAN Endoscopy Committee.

Pediatric Endoscopy and High Risk Patients: A Clinical Report from the NASPGHAN Endoscopy Committee.

J Pediatr Gastroenterol Nutr. 2019 Jan 16;:

Authors: Lightdale JR, Liu QY, Sahn B, Troendle DM, Thomson M, Fishman DS, NASPGHAN Endoscopy and Procedures Committee

Abstract
Pediatric gastrointestinal endoscopy has been established as safe and effective for diagnosis and management of many pediatric gastrointestinal diseases. Nevertheless, certain patient and procedure factors should be recognized that increase the risk of intra and/or post procedural adverse events. Adverse events associated with endoscopic procedures can broadly be categorized as involving sedation-related physiological changes, bleeding, perforation and infection. Factors which may increase patient risk for such adverse events include but are not limited to, cardiopulmonary diseases, anatomical airway or craniofacial abnormalities, compromised intestinal luminal wall integrity, coagulopathies and compromised immune systems. Examples of high-risk patients include patients with congenital heart disease, craniofacial abnormalities, connective tissues diseases, inflammatory bowel disease and children undergoing treatment for cancer. This clinical report is intended to help guide clinicians stratify patient risks and employ clinical practices that may minimize adverse events during and after endoscopy. These include use of CO2 insufflation, endoscopic techniques for maneuvers such as biopsies, and endoscope loop-reduction to mitigate the risk of such complications such as bleeding and intestinal perforation. Endoscopic infection risk and guidance regarding peri-procedural antibiotics are also discussed.

PMID: 30664560 [PubMed - as supplied by publisher]