Share this article on:

Challenges in Meeting Fellowship Procedural Guidelines in Pediatric Therapeutic Endoscopy and Liver Biopsy

Lerner, Diana G.*; Li, B.U.*; Mamula, Petar; Fishman, Douglas S.; Kramer, Robert§; Goh, Vi Lier||; El-Chammas, Khalil; Pentiuk, Scott P.#; Rothbaum, Robert**; Gurrum, Bhaskar*; Rahhal, Riad M.††; Goday, Praveen S.*; Vitola, Bernadette*

Journal of Pediatric Gastroenterology and Nutrition: January 2014 - Volume 58 - Issue 1 - p 27–33
doi: 10.1097/MPG.0000000000000184
Original Articles: Gastroenterology

Objective: The aims of this study were to assess the opportunities for therapeutic endoscopy, liver biopsies, and percutaneous endoscopic gastrostomy (PEG) placements available to fellows during a 3-year pediatric gastroenterology fellowship, and to evaluate access to ancillary procedural-training opportunities.

Methods: Data were collected from 12 pediatric gastroenterology fellowship programs in the United States. Procedures completed in the years 2009–2011 were queried using CPT codes and endoscopy databases. The maximal opportunity for procedures was based on the total procedures performed by the institution in 3 years divided by the total number of fellows in the program. The centers completed a questionnaire regarding ancillary opportunities for endoscopic training.

Results: There is significant variability in pediatric endoscopic training opportunities in specialized gastrointestinal (GI) procedures. Under the 1999 guidelines, no centers were able to meet the thresholds for polypectomy and control of nonvariceal bleeding. The 2013 guidelines allowed the number of programs reaching polypectomy thresholds to increase by 67% but made no difference for control of bleeding despite a decrease in the threshold. Training in PEG placement was not available in 42% of the surveyed centers. Elective ancillary procedural training is offered by 92% of the surveyed centers.

Conclusions: Most training programs do not have the volume of therapeutic endoscopy procedures for all of the fellows to meet the training guidelines. Training in therapeutic endoscopy, PEG placement, and liver biopsy in pediatric GI fellowships should be supplemented using all of the possible options including rotations with adult GI providers and hands-on endoscopy courses. A shift toward evaluating competency via quality measures may be more appropriate.

*Medical College of Wisconsin, Milwaukee, WI

Children's Hospital of Philadelphia, Philadelphia, PA

Texas Children's Hospital, Houston, TX

§Children's Hospital of Colorado, Aurora, CO

||Boston University, Boston, MA

Mercy Medical Center, Mason City, IA

#Cincinnati Children's Hospital Medical Center, Cincinnati, OH

**St Louis Children's Hospital, St Louis, MO

††University of Iowa, Des Moines, IA.

Address correspondence and reprint requests to Bernadette Vitola, Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI 53226 (e-mail:

Received 31 March, 2013

Accepted 12 September, 2013

The authors report no conflicts of interest.

© 2014 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,