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Updated: Aug 30, 2025
Guidelines for Elective Pediatric Fiberoptic Intubation
Published on: January 17, 2011
Pediatric Endoscopy Quality Improvement Network (PEnQuIN) quality standards and indicators for pediatric endoscopy:
Catharine M Walsh1, Jenifer R Lightdale2
1Division of Gastroenterology, Hepatology and Nutrition and the Research and Learning Institutes, The Hospital for Sick Children, Department of Paediatrics and the Wilson Centre, University of Toronto, Toronto, Ontario, Canada.
Insights
New pediatric endoscopy quality standards were developed by the Pediatric Endoscopy Quality Improvement Network (PEnQuIN) and endorsed by the American Society for Gastrointestinal Endoscopy (ASGE). These guidelines improve pediatric endoscopic care quality and safety.
Area of Science:
- Pediatric Gastroenterology
- Endoscopic Quality Improvement
- Clinical Guidelines Development
Background:
- Current endoscopy quality guidelines lack pediatric applicability, necessitating specialized metrics.
- The Pediatric Endoscopy Quality Improvement Network (PEnQuIN) was established to address this gap.
- The American Society for Gastrointestinal Endoscopy (ASGE) endorsed the developed pediatric quality standards.
Framework:
- The Appraisal of Guidelines for REsearch and Evaluation II (AGREE II) instrument guided guideline development.
- Grading of Recommendation Assessment, Development, and Evaluation (GRADE) approach was used for evidence and recommendations.
- An online Delphi process facilitated consensus on reporting elements.
Implementation:
- Consensus reached on 49 quality standards, 47 indicators, and 30 reporting elements for pediatric endoscopy.
- Minimal acceptable standards defined for terminal ileal intubation (≥85%), cecal intubation (≥90%), and bowel preparation (≥80%).
- Terminal ileal intubation recognized as crucial for high-quality pediatric endoscopy.
Implications:
- PEnQuIN guidelines provide international agreement on pediatric-specific endoscopic metrics.
- These guidelines promote safe, high-quality, patient- and family-centered endoscopic care for children.
- Adoption of PEnQuIN standards by providers and facilities is recommended for pediatric endoscopy services.
Background And Aims:
Current endoscopy quality guidelines largely focus on cancer screening-related metrics that are not applicable to pediatric populations. Through an international Pediatric Endoscopy Quality Improvement Network (PEnQuIN), quality standards and indicators for pediatric endoscopic procedures were developed and endorsed by the American Society for Gastrointestinal Endoscopy (ASGE).
Methods:
The Appraisal of Guidelines for REsearch and Evaluation II instrument guided PEnQuIN members, from 31 centers representing 11 countries, in generating and refining proposed quality standards and indicators. Quality of evidence and strength of recommendations were rated according to the Grading of Recommendation Assessment, Development, and Evaluation approach. Consensus on reporting elements was sought with an iterative online Delphi process.
Results:
Forty-nine quality standards and 47 indicators, encompassing pediatric endoscopy facilities, procedures, and endoscopists, as well as 30 reporting elements essential for inclusion within a pediatric endoscopy report reached consensus. Minimal acceptable standards were defined for 3 key indicators related to pediatric lower endoscopy: terminal ileal intubation rate ≥85%, cecal intubation rate ≥90%, and rate of adequate bowel preparation ≥80%. There was strong consensus that terminal ileal intubation, rather than cecal intubation, is integral to ensuring high-quality endoscopic care in children.
Conclusions:
The PEnQuIN guidelines establish international agreement on clinically meaningful metrics tailored to pediatric endoscopy that can be used to promote safe, high-quality, patient- and family-centered endoscopic care. Moving forward, it is recommended that all providers and facilities involved in endoscopy service for children adopt the PEnQuIN standards, indicators, and key reporting elements outlined in these ASGE-endorsed guidelines.
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