Objectives and Study

Patient satisfaction (PS) can be considered the final aim of healthcare. International gastroenterological societies recommend the assessment of PS as an integral part of quality improvement programs. In 2019 the Endoscopy special interest group of the Italian Society of Paediatric Gastroenterology (SIGENP) launched EndoPed, a nationwide paediatric endoscopy (PE) survey based on PEnQuIN quality standards and indicators. The survey came equipped with a PS questionnaire. A secondary aim of the study was to identify improvement fields based on patients’ suggestions.

Methods

The smartphone app-based prospective survey involved 24 paediatric endoscopy centres (PECs) in Italy. Indications and PEnQuIN endoscopy standards fulfilment were recorded. The modified GAHH-9m satisfaction questionnaire was composed by 7 Likert-scale questions exploring waiting times, communication and staff evaluation. Two additional closed questions investigated the will to confirm the endoscopist or the facility. We focused on data from upper endoscopy (EGDS).

Results

Questionnaire results were available for 1484 (56%) procedures [291 operatives, 9 complicated]. Questionnaire internal consistency was good (Cronbach’s α 0.89). Overall satisfaction was high (figure). Unsatisfaction (cut-off < 7/10) was higher in IBD and polyposis but also in abdominal pain, H. Pylori, and coeliac disease. At logistic regression analysis, unsatisfied patients were more likely to wait longer for the procedure (OR 4.3, p <0.001), and less likely to have been treated by an experienced endoscopist (OR 0.8, p <0.01). Patients treated by adult gastroenterologists tend to give lower average ratings to single questions. They are less likely to give the highest score to the overall experience and less likely to confirm the centre for future procedures (OR 0.3; 0.02; p<0.001).

Conclusions

A strong commitment is needed to decrease waiting times. High-quality education should be implemented to offset lower expertise with training. Investing in creating a “children friendly” environment could help adult facilities to improve patients’ perceived quality.

Objectives and Study

The intestinal tract is a major target of SARS-CoV-2 infection. Gastrointestinal symptoms have been reported in up to 20% of children during acute COVID-19. The long COVID (LC) syndrome defines any otherwise unexplained symptom occurring for 3 months after acute COVID-19 and gastro-intestinal symptom in long Covid (GI-LC) have been reported in 15-20% of patients.We report the prevalence and risk factors of GI-LC in a cohort of children enrolled in a LC survey.

Methods

A multi center prospective analysis included children (0-17 years) with a previous diagnosis of SARS-CoV-2 infection,from March 2022 to November 2022. GI-LC was investigated using a pretested questionnaire (ISARIC) at a median (interquartile range) of 2.4 (2.0-2.9),5.4 (5.0-5.9) and 8.4 (8.0-8.8) months after acute COVID-19 as defined by CDC LC definition.

Results

GI-LC was reported in 178/925 cases (19.2%) progressively decreasing thereafter (table).No significant differences were found between children with and without GI-LC in terms of age, vaccination rates and hospitalization (p>0.05). A previous GI comorbidity and overweight/obesity were reported more frequently in children with GI-LC rather than without (7.9 % vs 2.1 %, p<0.001, and 2.3% vs 0.5%, p=0.05). In children with GI-LC compared to those without,a higher prevalence of abdominal pain (21.4% vs 8.6%, p<0.001) and diarrhea (19.1% vs 9%, p<0.001) during the acute phase of COVID-19 was reported.

Table: LC-GI symptoms prevalence at follow-up.

Conclusions

GI-LC symptoms were reported in 19.2% of children with previous SARS-CoV-2 infection. Significantly associated factors to GI-LC were gastrointestinal comorbidity, overweight/obesity and GI symptoms during the acute phase of COVID-19. Abdominal pain and diarrhea were the most common GI symptoms of LC.

Objectives and Study

Hereditary Pancreatitis (HP) is a rare inherited condition. We reviewed our experience over the last 30 years.

The aim of our study was to evaluate the clinical course of HP in children.

Methods

495 children with chronic pancreatitis, hospitalized since 1990 to 2022, were enrolled into the study. The medical records of these patients were reviewed for data on the presentation, diagnostic findings and endoscopic treatment. All children were screened for the PRSS1 gene mutations.

Results

Hereditary pancreatitis was diagnosed in 72 patients (14.5%) (47 girls and 25 boys). PRSS1 gene mutations were found in 61 patients (85%). We detected R122H/- in 22, R122C/- in 21, N29I/- in 6, A16V/- in 6, E79K/- in 5, E190K/- and N29T/- in 1 patient. Family history was positive in 56 children with HP (88%). In 11 patients without mutations diagnosis of HP was made when the patients satisfied the requirements of the family history. In 3 patient we found SPINK1 mutation (N34S/-). In 2 children CFTR mutation (delF508/- and M470V/M470V) was present. There was no difference in age of the disease onset between HP group and non-HP group (7.5 vs. 9.1 years; NS). In children with PRSS1 mutation ERCP had mean 2,2^o Cambridge grade, vs. 1.6^o, p<0.05. 44% patients with HP had calcifications in the imagine studies vs. 31%, p<0.05. Therapeutic intervention, including both surgical and endoscopic intervention, was more frequent in the HP group (59% vs. 35%; p<0.05). Pancreatic duct stenting was done in 33% children with HP vs. 26%; p<0.05.

Conclusions

Hereditary pancreatitis is a common cause of CP in children and has worse clinical course than CP in children without PRSS1 mutations.

Objectives and Study

Given the variability in endoscopy training, use of standardized coaching language for teaching trainees endoscopy may help to enhance the clarity of instruction and reduce trainees’ cognitive load. Its effectiveness in fostering skills improvement has not been systematically evaluated. This study aimed to determine if the use of standardized coaching language by trainers is associated with improved colonoscopy performance and clarity of instruction.

Methods

A single-center, pre-post randomized control trial (RCT) design was used. Adult and pediatric gastroenterology faculty and fellows were randomly paired for a colonoscopy teaching encounter on a virtual reality simulator. After the first simulated colonoscopy (pre-session), the faculty were assigned in a 1:1 ratio to view an instructional video outlining standardized coaching language for endoscopy and its application during teaching (training group) or a control video on goal setting (control group). Following this, a second simulated colonoscopy (post-session) occurred 2 weeks later with the same faculty-fellow pairing. All sessions were video- and audio-recorded, without identifiers, for assessment by blinded external raters. The primary outcome is colonoscopy performance. Secondary outcomes include time in ‘red-out’, time to cecum, cognitive load (NASA-Task Load Index [TLX]), clarity of trainer’s instruction and adherence to standard terminology. Paired t-tests were used to evaluate pre-post differences.

Results

A total of twenty-five faculty-fellow pairs (18 pediatric, 7 adult) participated. Preliminary analysis of 10 faculty-fellow pairs (5 in each group) has shown significant improvement in the training group regarding time to cecum, red-out time, and trainees’ cognitive load in both the combined workload score and effort domain of the NASA-TLX (p<0.05), but not in the control group.

Conclusions

The interim analysis of this RCT shows that using standardized training language can potentially reduce the trainees’ cognitive load while learning colonoscopy and enhance training quality. Completed data analysis is needed to further support the benefits of this intervention.

Objectives and Study

Potential Celiac Disease (PCD) is characterized by positive celiac serology without villous atrophy. We describe patients with PCD who remained on a gluten-containing diet (GCD) and studied their short-term outcome.

Methods

This was a retrospective analysis of children with PCD who continued a GCD, between 12/2018 - 1/2022 at four Pediatric Gastroenterology units in Israel. Baseline data included demographic data, celiac serology and duodenal biopsy results. Follow-up data included repeated serology and biopsy results when performed. Patients were followed for a minimum of 12 months, unless celiac disease (CeD) was diagnosed earlier

Results

PCD was diagnosed in 90 children (71% females), mean age of 7.2 (range 1.8 - 16.5) years. At diagnosis anti-tissue transglutaminase (TTG) levels were above 10 times upper limit of normal (ULN) in 17/90 (18.9%), 3-10 x ULN in 56/90 (62.2%) and 1-3 x ULN in 17/90 (18.9%). During a mean follow-up of 17.6 months, (range 5-35m), TTG normalized in 34/90 (37.8%), decreased or remained unchanged in 48/90 (53.3%), and increased or remained >10 x ULN in 8/90 (8.9%). A repeated endoscopy was performed in 20/90 (22.2%) patients, leading to the diagnosis of CeD in 12; thus at end of follow-up, 12/90 (13.3%) were diagnosed with CeD and 78 (86.7%) remained PCD. In the subgroup of patients with TTG >10 x ULN at diagnosis, TTG levels normalized in 5/17; decreased but remained 3-10 x ULN in 8/17; and remained above 10 x ULN in 4/17. At the end of follow-up, 14/17 (82.4%) of patients with TTG >10 x ULN remained PCD.

Conclusions

During short-term follow up of 90 PCD patients, less than 15% progressed to CeD. Over a third normalized TTG levels. A fifth had a repeat endoscopy of which 60% were diagnosed with CeD. Periodic serological and histological follow-up is essential for PCD patients.

Objectives and Study

Pancreatic fluid collections (PFCs) are a well-known complication of pancreatitis. The operative management usually involves drainage; in adult patients endoscopic drainage is a well established treatment, while data in children are limited. Endoscopic ultrasonography (EUS) guidance has the advantages to localize non-bulging PFCs, to measure them, to confirm correct placement of the stent. Novel lumen-apposing metal stents (LAMS), such as HotAxios^®, present multiple advantages thanks to their peculiar design. In this study, we report our single-center experience of EUS-guided pseudocystogastrostomy with LAMS positioning in children with PFCs.

Methods

Demographics, clinical and laboratory data, imaging, operative and follow up results were collected from medical records and outpatient’s clinic visits.
All consecutive children with PFC undergone EUS-guided pseudocystogastrostomy and LAMS positioning between Apr-2020 and Nov-2022 were enrolled in this retrospective study. PFCs were preoperative evaluated using CT scans. Clinical success was defined as resolution of PFCs. We also evaluated technical success, adverse events, recurrence rates and rate of re-interventions. Follow-up included clinical observation, blood tests with blood count, serum amylases and lipases, and US.

Results

Echo-endoscopic cystogastrostomy was performed in 3 children (2 male; median age 13,2years). Median cyst diameter was 12.3cm (range 6.8-22cm). All procedures were performed under general anesthesia. In all patients a LAMS HotAxios^® 10x15mm was used, and a necrosectomy was perform through it. Technical success rates were 100%. No intraoperative complications were detected. No postoperative complicationsoccurred.

Conclusions

Our experience suggests that EUS-guided pseudocystogastrostomy can be considered a safe and feasible procedure in treatment of PCFs even in the pediatric population. Advantages of LAMS HotAxios^® include single-step deployment, anti-migration structure and allowing to perform necrosectomy. This procedure should be performed by an expert Endoscopist in a tertiary-level Center to reduce adverse events.