Variability in antroduodenal and colonic manometry protocols across pediatric centers worldwide
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Published on: January 21, 2015
Lev Dorfman1,2,3, Khalil El-Chammas1,4, Lin Fei5
1Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Insights
Pediatric antroduodenal (ADM) and colonic (CM) manometry protocols show significant global variability in study length and drug stimulation. Standardized guidelines are crucial for consistent gastrointestinal motility disorder assessments.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Motility Disorders
- Diagnostic Procedures
Background:
- Antroduodenal manometry (ADM) and colonic manometry (CM) are key diagnostic tools for pediatric gastrointestinal motility disorders.
- Existing minimal standards lack comprehensive protocol uniformity.
- Global assessment of ADM and CM protocol diversity is lacking.
Purpose of the Study:
- To evaluate the diversity in antroduodenal (ADM) and colonic (CM) manometry protocols across pediatric centers worldwide.
- To identify variations in study parameters and pharmacological stimulations.
- To highlight the need for standardized international guidelines.
Main Methods:
- A cross-sectional study utilizing an anonymous global survey of pediatric centers.
- Comparison of protocols between United States (US) and non-US centers.
- Data collection on study timing, duration, and pharmacological agents used.
Main Results:
- Significant variability observed in ADM study timing (same-day vs. next-day) and duration (4-24 hours).
- Widespread use of erythromycin (87.9%) for ADM stimulation, with US centers employing more pharmacological agents (96.8%) than non-US centers (50%).
- CM studies also showed variability in duration (4-24 hours), with 89.2% using bisacodyl for stimulation.
Conclusions:
- Substantial heterogeneity exists in pediatric ADM and CM protocols globally.
- Variations in study length and pharmacological stimulation impact diagnostic consistency.
- Development and implementation of universal standardized guidelines are urgently needed for ADM and CM studies.
Background:
Antroduodenal (ADM) and colonic (CM) manometries are performed in pediatric patients to evaluate gastrointestinal motility disorders. While minimal standards for performing ADM and CM have been published, there are no standardized protocols for performance of these studies. We aimed to evaluate the diversity in ADM and CM protocols in pediatric centers worldwide.
Methods:
A cross-sectional study using an anonymous survey was conducted among pediatric centers worldwide comparing US and non-US centers.
Results:
Responses were received from 37 pediatric centers. ADM: 17 (45.9%) centers perform next-day and 14 (37.8%) centers perform same-day studies. Study length ranges from 4 to 24 hours. Erythromycin stimulation is implemented by 29/33 (87.9%), azithromycin by 15/33 (45.5%) and octreotide by 7/33 (21.2%) centers. US centers perform more pharmacological stimulations (30/31 (96.8%) vs. 3/6 (50%), p = 0.0018), while non-US centers conduct longer studies (15.3 hours vs. 7.4 hours, p = 0.0291). CM: 17 (45.9%) centers perform same-day studies with length from 4 to 24 hours, and 89.2% perform pharmacological stimulation, all using bisacodyl.
Conclusions:
Significant variability exists in ADM and CM protocols among pediatric centers, affecting study length and pharmacological stimulation. Universal standardized guidelines are needed to ensure uniformity in the performance and interpretation of these studies.
Impact:
Pediatric gastroenterological societies set minimal standards for antroduodenal (ADM) and colonic (CM) manometry studies, allowing variability in timing, fasting, postprandial phases, and provocation tests. Protocol variability among pediatric centers worldwide has not been previously assessed. This study offers a real-life overview of ADM and CM practices in pediatric centers worldwide, highlighting the need for standardized guidelines due to observed variability in timing, duration, and pharmacologic stimulation. The lack of standardization affects study interpretation and underscores the importance of developing universal guidelines.
