Background and study aims The ability to perform endoscopy procedures safely and effectively is a key aspect of quality clinical care in Pediatric Gastroenterology, Hepatology and Nutrition (PGHN). The aim of this survey, which was part of a global survey on PGHN training in Europe, was to assess endoscopy training opportunities provided across Europe. Methods Responses to standardized questions related to endoscopy training were collected from training centers across Europe through the presidents/representatives of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition National Societies from June 2016 to December 2019. Results A total of 100 training centers from 19 countries participated in the survey. In 57 centers, the endoscopy suit was attached to the PGHN center, while in 23, pediatric endoscopies were performed in adult endoscopy facilities. Ninety percent of centers reported the availability of specialized endoscopy nurses and 96 % of pediatric anesthetists. Pediatric endoscopies were performed by PGHN specialists in 55 centers, while 31 centers reported the involvement of an adult endoscopist and 14 of a pediatric surgeon. Dividing the number of procedures performed at the training center by the number of trainees, ≤ 20 upper, lower, or therapeutic endoscopies per trainee per year were reported by 0 %, 23 %, and 56 % of centers, respectively, whereas ≤ 5 wireless capsule endoscopies per trainee per year by 75 %. Only one country (United Kingdom) required separate certification of competency in endoscopy. Conclusions Differences and deficiencies in infrastructure, staffing, and procedural volume, as well as in endoscopy competency assessment and certification, were identified among European PGHN training centers limiting training opportunities in pediatric endoscopy.

2nd Department of Pediatrics Saint Marina University hospital Varna Bulgaria

4th Department of Pediatrics Aristotle University of Thessaloniki Thessaloniki Greece

Birmingham Children's Hospital NHS Foundation Trust Birmingham United Kingdom

Department of Gastroenterology Hepatology and Nutrition Ljubljana University Children's Hospital Ljubljana Slovenia

Department of Pediatric Gastroenterology Erasmus MC Sophia Children's Hospital Rotterdam The Netherlands

Department of Pediatric Gastroenterology Leuven University Hospital Leuven Belgium

Department of Pediatrics and Adolescent Medicine University Medical Center Ulm Ulm Germany

Department of Pediatrics Medical University of Graz Graz Austria

Department of Pediatrics University Hospital Motol Prague Czech Republic

Department of Translational Medical Science Section of Pediatrics University of Naples Federico 2 Naples Italy

Division of Gastroenterology and Hepatology 1st Department of Pediatrics University of Athens Children's Hospital Agia Sofia Athens Greece

Division of Pediatric Gastroenterology and Nutrition University Children's Hospital Basel Switzerland

Division of Pediatric Gastroenterology Department of Pediatrics Ankara University School of Medicine Ankara Turkey

Pediatric Gastroenterology Unit Department of Pediatrics Hadassah University Hospitals Jerusalem Israel

Pediatric Gastroenterology Unit La Fe University Hospital Valencia Spain

Pediatric Gastroenterology Unit University Hospital Puerta de Hierro Majadahonda Madrid Spain

Pediatric Liver Center King's College Hospital London United Kingdom

Sheffield Children's Hospital NHS Foundation Trust Sheffield United Kingdom

Unit of Gastroenterology Hepatology Nutrition Diabetes and Inborn Errors of Metabolism Children Hospital Toulouse University Hospital Toulouse France

University Hospital Center Zagreb Division for Pediatric Gastroenterology Hepatology and Nutrition and University of Zagreb School of Medicine Zagreb Croatia

Vilnius University Clinic of Children's Diseases Vilnius Lithuania

Zobrazit více v PubMed

European Training Requirements for Training in Paediatric Gastroenterology, Hepatology and Nutrition. https://www.espghan.org/knowledge-center/education/ESPGHAN_Training_Syllabus_2019 https://www.espghan.org/knowledge-center/education/ESPGHAN_Training_Syllabus_2019

Broekaert I, Tzivinikos C, Narula P et al.European Society for Paediatric Gastroenterology, Hepatology and Nutrition Position Paper on Training in Paediatric Endoscopy. J Pediatr Gastroenterol Nutr. 2020;70:127–140. PubMed

Cohen J, Pike I M. Defining and measuring quality in endoscopy. Gastrointest Endosc. 2015;81:1–2. PubMed

Armstrong D, Barkun A, Bridges R et al.Canadian association of gastroenterology consensus guidelines on safety and quality indicators in endoscopy. Can J Gastroenterol. 2012;26:17–31. PubMed PMC

Faigel D O, Pike I M, Baron T H et al.Quality indicators for gastrointestinal endoscopic procedures: An introduction. Am J Gastroenterol. 2006;101:866–872. PubMed

Kramer R E, Walsh C M, Lerner Di G et al.Quality Improvement in Pediatric Endoscopy: A Clinical Report from the NASPGHAN Endoscopy Committee. J Pediatr Gastroenterol Nutr. 2017;65:125–131. PubMed

Narula P, Broughton R, Howarth L et al.Paediatric Endoscopy Global Rating Scale: Development of a Quality Improvement Tool and Results of a National Pilot. J Pediatr Gastroenterol Nutr. 2019;69:171–175. PubMed

Rutter M D, Rees C J. Quality in gastrointestinal endoscopy. Endoscopy. 2014;46:526–528. PubMed

Leichtner A M, Gillis L A, Gupta S et al.NASPGHAN Training Committee; North American Society for Pediatric Gastroenterology. NASPGHAN guidelines for training in pediatric gastroenterology. J Pediatr Gastroenterol Nutr. 2013;56:S1–S8. PubMed

Thomson M, Tringali A, Dumonceau J M et al.Paediatric Gastrointestinal Endoscopy: European Society for Paediatric Gastroenterology Hepatology and Nutrition and European Society of Gastrointestinal Endoscopy Guidelines. J Pediatr Gastroenterol Nutr. 2017;64:133–153. PubMed

Pall H, Lerner D, Khlevner J et al.Developing the Pediatric Gastrointestinal Endoscopy Unit: A Clinical Report by the Endoscopy and Procedures Committee. J Pediatr Gastroenterol Nutr. 2016;63:295–306. PubMed

Ward S T, Mohammed M A, Walt R et al.An analysis of the learning curve to achieve competency at colonoscopy using the JETS database. Gut. 2014;63:1746–1754. PubMed PMC

Broekhart I, Jahnel J, Moes N et al.Evaluation of a European-wide survey on pediatric endoscopy training. Frontline Gastroenterol. 2019;10:188–193. PubMed PMC

Papadopoulou A, Ribes-Koninckx C, Noni M et al.Training in pediatric hepatology across Europe: a survey of the ESPGHAN National Societies Network 2016–2019. Ann Gastroenterol. 2022;35:1–7. PubMed PMC

Athiana I, Légeret C, Bontems P. Significant variations across European centres in implementing recommended guidelines for the paediatric gastroenterology endoscopy suite during the COVID-19 pandemic. JPGN Reports. 2021 doi: 10.1097/PG9.0000000000000061. PubMed DOI PMC

International Database: World Population Estimates and Projections. https://www.census.gov/data-tools/demo/idb/#/map?COUNTRY_YR_ANIM=2021&menu=mapViz&COUNTRY_YEAR= https://www.census.gov/data-tools/demo/idb/#/map?COUNTRY_YR_ANIM=2021&menu=mapViz&COUNTRY_YEAR=

Royal College of Physicians . UK Inflammatory Bowel Disease Audit: A summary report on the quality of healthcare provided to people with inflammatory bowel disease. 2014. https://www.rcplondon.ac.uk/file/2441/download https://www.rcplondon.ac.uk/file/2441/download

Orel R, Brecelj J, Dias J A et al.Review on sedation for gastrointestinal tract endoscopy in children by non-anesthesiologists. World J Gastrointest Endosc. 2015;7:895–911. PubMed PMC

Oliva S, Dias J A, Alateeqi A et al.The pediatric endoscopy practice in Europe: preliminary results of a web-based survey on behalf of the Endoscopy Special Interest Group of European Society for Paediatric Gastroenterology, Hepatology and Nutrition. https://www.giejournal.org/article/S0016-5107%2820%2933229-6/fulltext Gastrointest Endosc. 2020;91:AB501.

Parry B R, Williams S M. Competency and the colonoscopist: a learning curve. Aust N Z J Surg. 1991;61:419–422. PubMed

PGHN Guidance Checklist. https://studylib.net/doc/7595104/pghn-guidance-checklist https://studylib.net/doc/7595104/pghn-guidance-checklist

Ward S T, Mohammed M A, Walt R et al.An analysis of the learning curve to achieve competency at colonoscopy using the JETS database. Gut. 2014;63:1746–1754. PubMed PMC

DʼAntiga L, Nicastro E, Papadopoulou A et al.European Society for Pediatric Gastroenterology, Hepatology, and Nutrition syllabus for subspecialty training: Moving towards a European standard. J Pediatr Gastroenterol Nutr. 2014;59:417–422. PubMed

Faulx A L, Lightdale J R, Acosta R D et al.Guidelines for privileging, credentialing, and proctoring to perform GI endoscopy. Gastrointest Endosc. 2017;85:273–281. PubMed

Jorgensen J E, Elta G H, Stalburg C M et al.Do breaks in gastroenterology fellow endoscopy training result in a decrement in competency in colonoscopy? Gastrointest Endosc. 2013;78:503–509. PubMed

Singh S, Sedlack R E, Cook D A. Effects of simulation-based training in gastrointestinal endoscopy: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2014;12:1611–1.623E7. PubMed

Walsh C M. Training and assessment in pediatric endoscopy. Gastrointest Endosc Clin N Am. 2016;26:13–33. PubMed

Sewell J L, Boscardin C K, Young J Q et al.Learner, patient, and supervisor features are associated with different types of cognitive load during procedural skills training: implications for teaching and instructional design. Acad Med. 2017;92:1622–1631. PubMed

Huang C, Hopkins R, Huang K et al.Standardizing endoscopy training: a workshop for endoscopy educators. MedEdPORTAL. 2020;16:11015. PubMed PMC

Umar S B, Oxentenko A S. Training the trainers: setting standards for faculty in gastroenterology. Clin Gastroenterol Hepatol. 2021;19:861–868. PubMed

Zanchetti D J, Schueler S A, Jacobson B C et al.Effective teaching of endoscopy: a qualitative study of the perceptions of gastroenterology fellows and attending gastroenterologists. Gastroenterol Rep (Oxf) 2016;4:125–130. PubMed PMC

Romano P S, Volpp K. The ACGMEʼs 2011 changes to resident duty hours: Are they an unfunded mandate on teaching hospitals? J Gen Intern Med. 2012;27:136–138. PubMed PMC

Epstein R M. Assessment in medical education. N Engl J Med. 2007;356:387–396. PubMed

Walsh C M, Ling S C, Walters T D et al.Development of the gastrointestinal endoscopy competency assessment tool for pediatric colonoscopy (GiECATKIDS) J Pediatr Gastroenterol Nutr. 2014;59:480–486. PubMed

(Model) Specialty Training Regulations 2018. German Medical Association (Joint Association of the State Chambers of Physicians in Germany) https://www.bundesaerztekammer.de/fileadmin/user_upload/downloads/pdf-Ordner/Weiterbildung/20210630_MWBO_2018.pdf https://www.bundesaerztekammer.de/fileadmin/user_upload/downloads/pdf-Ordner/Weiterbildung/20210630_MWBO_2018.pdf