Numbers matter: How pediatric endoscopy quality varies with annual procedural volume

There is limited data linking pediatric endoscopist experience and procedural quality. We aimed to examine the associations of faculty physicians' years in practice and independent annual procedural volume (APV) with published quality indicators for pediatric endoscopy, including terminal ileal intubation rate (TIIR), cecal intubation rate (CIR), and total procedure time.

We extracted quality indicators, as defined by the Pediatric Endoscopy Quality Improvement Network (PEnQuIN), for ileocolonoscopies performed by faculty endoscopists at a pediatric tertiary-care academic institution from October 2021 to May 2024. Endoscopists were categorized by years' experience and APV. Quality indicators were compared across groups using Kruskal-Wallis analyses. Multivariate modeling was performed to identify variables predicting terminal ileal intubation and TIIR ≥ 85%. Proportional hazards modeling was performed to identify variables predicting shorter procedure duration for combined esophagogastroduodenoscopy and ileocolonoscopy procedures.

Nine hundred and eighty-five ileocolonoscopies were performed independently by 20 faculty endoscopists, with varying years' experience (<5 years: N = 7; 5-10 years: N = 3; ≥10 years: N = 10), and a median (interquartile range) APV of 19 (14, 45). Most procedures (71.7%) were scored as demonstrating adequate bowel preparation. Overall TIIR and CIR were 86.3% and 91.6%, respectively. In multivariate modeling, APV ≥ 40 was identified as predictive for TIIR ≥ 85% (p < 0.01) while faculty years' experience (≥10 vs. <10 years) predicted shorter procedure duration (adjusted hazard ratio [confidence interval]: 1.40 [1.23, 1.59]).

Our data showed a significant association between pediatric quality indicators and individual endoscopist APV and years of experience. Our findings also suggest that performing ≥40 ileocolonoscopies annually may help ensure high-quality endoscopic procedures in children.