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

Barakat, Monique T.*; Triadafilopoulos, George*; Berquist, William E.

Journal of Pediatric Gastroenterology and Nutrition: February 14, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/MPG.0000000000002310
Original Article: Gastroenterology: PDF Only

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.

*Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA 94305, United States

Division of Pediatric Gastroenterology, Lucille Packard Children's Hospital at Stanford University Medical Center, Stanford, CA 94305, United States.

Address correspondence and reprint requests to William E. Berquist, MD, Professor, Division of Pediatric Gastroenterology, Lucille Packard Children's Hospital at Stanford University Medical Center (e-mail:

Received 25 September, 2018

Accepted 25 January, 2019

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (

Disclosures: None of the authors have any conflicts of interest pertaining to the study to disclose.

Author Contributions: MTB, WEB and GT were involved in study concept and design, analysis and interpretation of data, critical revision of the manuscript for important intellectual content, MTB and WEB were involved in acquisition of data, WEB was responsible for study supervision, WEB and GT granted final approval of the manuscript.

© 2019 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,