Pediatric endoscopy training across Europe: a survey of the ESPGHAN National Societies Network 2016-2019

Abstract

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.

Fig. 1

Annual numbers of upper gastrointestinal endoscopies performed by the PGHN centers with the largest procedural volume among the participating in the survey centers which answered the corresponding question, in each country. The centers shown in the figure are the following: Vilnius (Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania); Sheffield (Sheffield Children’s Hospital, Sheffield, UK); Rome (Bambino Gesù Children's Hospital, Rome, Italy); Jerusalem (Shaare Zedek Medical Center, Jerusalem, Israel); Ljubljana (Ljubljana University Medical Center, Ljubljana, Slovenia); Paris (University Hospital Robert Debré, Paris, France); Leuven (University Hospitals Leuven, Leuven, Belgium); Prague (Motol University Hospital, Prague, Czech Republic); Ankara (Ankara University Hospital, Ankara, Turkey); Madrid (Niño Jesús University Hospital, Madrid, Spain); Darmstadt (Darmstädter Children’s Hospital Prinzessin Margaret, Darmstadt, Germany); Zagreb (Children’s Hospital Zagreb, Croatia same numbers with the University Hospital Center, Zagreb, Croatia), Amsterdam (Emma Childrens Hospital, Academic Medical Center, Amsterdam, The Netherlands); Porto (São João hospital center, Porto, Portugal); Athens (Agia Sofia Children's Hospital, Athens, Greece); Basel (Basel University Children’s Hospital, Basel, Switzerland) same numbers with St. Gallen (Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland); Debrecen (Debrecen University Children’s Hospital, Debrecen, Hungary); Innsbruck (Innsbruck Medical University Hospital, Innsbruck, Austria); Sofia (Sofia Medical University Hospital, Sofia, Bulgaria). PGHN: Pediatric Gastroenterology, Hepatology and Nutrition; No: number.

Fig. 2

Annual numbers of lower gastrointestinal endoscopies performed by the PGHN centers with the largest procedural volume among the participating in the survey centers which answered the corresponding question, in each country. The centers shown in the figure are the following: Sheffield (Sheffield Children’s Hospital, Sheffield, UK); Rome (Bambino Gesù Children's Hospital, Rome, Italy); Ramat Gan (Sheba Medical Center, Ramat Gan, Israel); Ljubljana (Ljubljana University Medical Center, Ljubljana, Slovenia); Lyon (Hospital Woman Mother Chil, Lyon, France); Leuven (University Hospitals Leuven, Leuven, Belgium); Amsterdam (Emma Childrens Hospital, Academic Medical Center, Amsterdam, The Netherlands); Barcelona (Hospital San Juan de Dios, Barcelona, Spain); Zagreb (University Hospital Center, Zagreb, Croatia); Prague (Motol University Hospital, Prague, Czech Republic); Debrecen (Debrecen University Children’s Hospital, Debrecen, Hungary); Athens (Agia Sofia Children's Hospital, Athens, Greece); Bremen (Bremen Children’s Hospital, Bremen, Germany) same numbers with Cologne (Cologne University Children’s Hospital, Cologne, Germany); Izmir (Dokuz Eylül University, Izmir, Turkey); Lisbon (University Hospital de Santa Maria, Lisbon Academical Medical Centre, Lisbon, Portugal); Sofia (Sofia Medical University Hospital, Sofia, Bulgaria); Innsbruck (Innsbruck Medical University Hospital, Innsbruck, Austria); Lausanne (Lausanne University Hospital, Lausanne, Switzerland); Vilnius (Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania). PGHN: Pediatric Gastroenterology, Hepatology and Nutrition; No: number.

Fig. 3

Annual numbers of therapeutic gastrointestinal endoscopies performed by the PGHN centers with the largest procedural volume among the participating in the survey centers which answered the corresponding question, in each country. The centers shown in the figure are the following: Rome (Bambino Gesù Children's Hospital, Rome, Italy); Birmingham (Birmingham Children’s Hospital, Birmingham, UK); Lyon (Hospital Woman Mother Chil, Lyon, France); Prague (Motol University Hospital, Prague, Czech Republic); Leuven (University Hospitals Leuven, Leuven, Belgium); Ramat Gan (Sheba Medical Center, Ramat Gan, Israel); Vilnius (Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania); Utrecht (Wilhelmina Childrens Hospital/University Medical Center Utrecht, Utrecht, The Netherlands); Porto (São João Hospital Center, Porto, Portugal); Ljubljana (Ljubljana University Medical Center, Ljubljana, Slovenia); Izmir (Dokuz Eylül University, Izmir, Turkey); Barcelona (Hospital San Juan de Dios, Barcelona, Spain); Athens (Agia Sofia Children's Hospital, Athens, Greece); Debrecen (Debrecen University Children's Hospital, Debrecen, Hungary); Zagreb (University Hospital Center, Zagreb, Croatia); Erlangen (Children’s Hospital Erlangen, Erlangen, Germany); Lausanne (Lausanne University Hospital, Lausanne, Switzerland); Vienna (Vienna University Children's Hospital, Vienna, Austria); Sofia (Sofia Medical University Hospital, Sofia, Bulgaria). PGHN: Pediatric Gastroenterology, Hepatology and Nutrition; No: number.

Fig. 4

Annual number of upper/lower/therapeutic gastrointestinal endoscopies per 100.000 pediatric inhabitants 0–19 years in countries with full representation of training centers in Pediatric Gastroenterology, Hepatology and Nutrition. GI, gastrointestinal; no, number.