Clinical Practice Survey of Repeat Endoscopy in Pediatric Inflammatory Bowel Disease in North America
Jonathan Moses1, Kelly Sandberg2, Gabriel Winberry3
1Division of Pediatric Gastroenterology, Hepatology and Nutrition, UH/Rainbow Babies and Children's Hospital, Cleveland, OH.
Insights
Most pediatric gastroenterologists use repeat endoscopy to check for endoscopic remission in pediatric inflammatory bowel disease (IBD). Practice patterns vary, and guidelines are needed to standardize care for children with IBD.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease (IBD) Research
- Endoscopic Assessment
Background:
- Endoscopic remission is a key treatment goal in inflammatory bowel disease (IBD).
- The adoption of this practice among pediatric gastroenterology providers is not well-defined.
- This study investigates the current use of repeat endoscopy in pediatric IBD management.
Purpose of the Study:
- To determine the frequency of repeat endoscopy in pediatric IBD patients.
- To identify provider characteristics that predict the use of repeat endoscopy.
- To understand the motivations and barriers influencing this practice.
Main Methods:
- A cross-sectional survey was distributed to pediatric gastroenterology providers via national listservs.
- Respondents provided baseline characteristics and detailed their approaches to repeat endoscopy.
- Motivations and barriers for performing or not performing repeat endoscopy were assessed.
Main Results:
- 65% of surveyed providers perform repeat endoscopy to assess endoscopic remission in pediatric IBD.
- 56% reported performing repeat endoscopy without a departmental protocol.
- Providers who repeat endoscopy cited insufficient symptom-based monitoring, while those who don't rely on clinical, biomarker, and imaging trends.
Conclusions:
- A majority of pediatric gastroenterology providers utilize repeat endoscopy for assessing endoscopic remission in pediatric IBD.
- Less experienced providers were more likely to perform repeat endoscopies.
- There is a clear need for North American pediatric guidelines supported by evidence on the long-term benefits of endoscopic remission.
Objectives:
Endoscopic remission has become a standard treatment target in inflammatory bowel disease (IBD). It is unclear how widely this practice has been adopted amongst pediatric gastroenterology providers. This study determines the frequency of repeat endoscopy in pediatric IBD and evaluates for predictive baseline characteristics of providers.
Methods:
We developed a cross-sectional survey, which was distributed via 3 national email listservs to pediatric gastroenterology providers. We obtained baseline characteristics of respondents and assessed motivations and barriers for the practice of repeat endoscopy compared with none.
Results:
Two hundred and thirty-eight unique respondents completed the online survey. Response rate was 11% (238 of 2300 possible participants). The majority practice in an academic setting (77%) and reported participation in ImproveCareNow (63%). Overall, 65% of respondents perform repeat endoscopy to assess for endoscopic remission in pediatric IBD as part of routine clinical practice. Fifty-six percent reported repeat endoscopy as individuals in the absence of a departmental protocol. "Symptoms are not sufficient to follow IBD patients" was reported by 82% of those who repeat endoscopy; conversely, "I perform endoscopy based on clinical, biomarker, and/or imaging trends" was reported by 81% of those who do not repeat endoscopy. The establishment of a pediatric-specific guideline was most commonly reported to change current practice, based on rank-order scoring.
Conclusions:
A majority of representative providers repeat endoscopy to assess for endoscopic remission in pediatric IBD. Fewer years in practice favored repeating endoscopy. The need for North American pediatric guidelines with pediatric-specific evidence to support the long-term benefits of endoscopic remission are highlighted in this study.
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