[Survey analysis on the development and current status of pediatric digestive endoscopy over past 40 years]

Objective: To understand the development and current status of pediatric digestive endoscopy over the past 40 years, so as to provide strategic recommendations for the discipline's future development. Methods: A cross-sectional survey was conducted between February and March 2025 across 504 hospitals practicing pediatric endoscopy in 31 provinces, autonomous regions or municipalities. The structured questionnaire encompassed institutional and endoscopy center profiles, workforce demographics, technical capabilities, and continuing education requirements. Results: All 504 distributed questionnaires were returned valid. Pediatric endoscopy was first established in 1985 in Zhejiang Province and Beijing, with the Xizang Autonomous Region commencing services in 2023. The 5 leading provinces by center volume were Shandong (65 hospitals), Zhejiang (47 hospitals), Jiangsu (36 hospitals), Sichuan (34 hospitals) and Guangdong (29 hospitals). Geographic distribution revealed significant disparities: East China dominated with 187 centers (37.1%), North China accounted for 51 (10.1%), Southwest China accounted for 84 (16.7%), South China accounted for 65 (12.9%), Central China accounted for 41 (8.1%), Northwest China accounted for 60 (11.9%), while Northeast China accounted for merely 16 (3.2%). The workforce comprised 2 089 physicians and 1 920 nurses (physician-to-nurse ratio 1∶0.92), with general hospitals demonstrating superior staffing ratios (1∶1.06) compared to pediatric specialized and maternal-child hospitals (1∶0.51). Training predominantly relied on external fellowships (49.4%, 249/504) or combined institutional-external programs (40.9%, 206/504), supervised mainly by pediatric endoscopists (75.2%, 342/455). Diagnostic and therapeutic capabilities achieved comprehensive gastrointestinal coverage, with the five most prevalent procedures being gastroscopy (100.0%,504/504), foreign body retrieval (89.7%,452/504), colonoscopy (74.6%,376/504), polypectomy (62.5%,315/504), and hemostasis (54.0%,272/504). Conversely, advanced interventions, including endoscopic retrograde cholangiopancreatography, endoscopic retrograde appendicitis therapy and peroral endoscopic myotomy remained limited in adoption. Between 1996 and 2025, 18 practice guidelines, consensus statements and standard operating protocols were published. Conclusions: Pediatric gastrointestinal endoscopy has developed rapidly, with progress in discipline development, technical standards, talent cultivation, and consensus guideline formulation. However, challenges remain in achieving regional balance, optimizing the doctor-nurse ratio, and advancing high-level endoscopic therapeutic technologies. Future efforts should focus on refining minimally invasive technologies, integrating intelligent technologies, and achieving integrated management across the entire service chain.