Mobile Health technology in pediatric esophagogastroduodenoscopy quality indicators assessment: results from a national program of the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition

Lorenzo Norsa; Francesco Morotti; Cecilia Mantegazza; Milena Meroni; Marco Deganello Saccomani; Claudia Banzato; Barbara Parma; Giulia Franchino; Giovanni Di Nardo; Naire Sansotta; Paolo Orizio; Emanuele Dabizzi; Giorgio Raffaele Fava; Andrea Chiaro; Maristella Pellegrino; Fabiola Fornaroli; Antonio Pizzol; Caterina Strisciuglio; Caterina Pacenza; Cosimo Ruggiero; Giusy Russo; Salvatore Oliva

doi:10.1016/j.gie.2024.03.019

Mobile Health technology in pediatric esophagogastroduodenoscopy quality indicators assessment: results from a national program of the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition

Gastrointest Endosc. 2024 Mar 19:S0016-5107(24)00180-9. doi: 10.1016/j.gie.2024.03.019. Online ahead of print.

Authors

Lorenzo Norsa¹, Francesco Morotti², Cecilia Mantegazza³, Milena Meroni⁴, Marco Deganello Saccomani⁵, Claudia Banzato⁵, Barbara Parma⁶, Giulia Franchino⁶, Giovanni Di Nardo⁷, Naire Sansotta⁸, Paolo Orizio⁹, Emanuele Dabizzi¹⁰, Giorgio Raffaele Fava¹¹, Andrea Chiaro¹², Maristella Pellegrino¹³, Fabiola Fornaroli¹⁴, Antonio Pizzol¹⁵, Caterina Strisciuglio¹⁶, Caterina Pacenza¹⁷, Cosimo Ruggiero¹⁸, Giusy Russo¹⁸, Salvatore Oliva¹⁸

Affiliations

¹ Pediatric Hepatology Gastrosenterology and Transplantation Unit, ASST Papa Giovanni XXIII, Bergamo, Italy; Deparment of Pediatrics, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy. Electronic address: lonorsa@hotmail.com.
² Division of Pediatrics, Department of Health Sciences, Università degli Studi del Piemonte Orientale, Novara, Italy; Neonatology and Neonatal Intensive Care Unit, Spedali Civili Children's Hospital, Brescia, Italy.
³ Deparment of Pediatrics, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy.
⁴ Department of Pediatric Surgery, Vittore Buzzi Children's Hospital, Milan, Italy.
⁵ Department of Pediatrics, Woman's & Child's University Hospital of Verona, Italy.
⁶ Department of Pediatric, Mariani Foundation Center for Fragile Child. ASST-Lariana, Sant'Anna Hospital, San Fermo della Battaglia, Como, Italy.
⁷ Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Pediatric Unit, Sant'Andrea University Hospital, Rome, Italy.
⁸ Pediatric Hepatology Gastrosenterology and Transplantation Unit, ASST Papa Giovanni XXIII, Bergamo, Italy.
⁹ Department of Pediatric Surgery, Spedali Civili Children's Hospital, Brescia, Italy.
¹⁰ Gastroenterology and Interventional Endoscopy Unit, AUSL Bologna, Surgical Department, Bologna, Italy.
¹¹ Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
¹² Pediatric Gastroenterology and Endoscopy Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy.
¹³ Pediatric Surgery Departement, ASST GOM Niguarda, Milan - Italy.
¹⁴ Gastroenterology and Endoscopy Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy.
¹⁵ Pediatric Gastroenterology Unit, Regina Margherita Children's Hospital, Azienda Ospedaliera-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy.
¹⁶ Department of Woman, Child, General and Specialistic Surgery, University of Campania "Luigi Vanvitelli," Naples, Italy.
¹⁷ Department of Pediatrics, San Giovanni di Dio Hospital, Crotone, Italy.
¹⁸ Pediatric Gastroenterology and Liver Unit, Maternal and Child Health Department, Sapienza University of Rome, Rome, Italy.

PMID: 38513921
DOI: 10.1016/j.gie.2024.03.019

Abstract

Background and aims: Upper endoscopy procedures (UEP, esophagogastroduodenoscopy [EGDS] and retrograde endoscopic retrograde cholangiography [ERCP]) are an established standard of care in pediatric gastroenterology. The Pediatric endoscopy quality improvement network (PEnQuIN) recently published its pediatric-specific endoscopy quality guidelines. This study, initiated by the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition (SIGENP), aims to evaluate the adherence of Italian Pediatric Endoscopy Centers to these established quality standards.

Methods: Conducted between April 2019 and March 2021, this nationwide study utilized a smartphone app-based approach. Data encompassing pediatric endoscopy facilities, patient profiles, endoscopy indications, 17 procedure-related PEnQuIN indicators, and a GHAA-9m patient satisfaction questionnaire were systematically collected.

Results: A comprehensive analysis of 3582 procedures from 24 PECs revealed that 2654 (76%) were UEP. The majority of centers (75%) involved more than one operator, with 9 PEC incorporating adult endoscopists, responsible for 5% of UEPs. Overall, adherence to quality standards was good; however, areas of improvement include sub-optimal reporting of sedation details, adherence to disease-specific guidelines, and patient satisfaction questionnaire completeness (56%). The complication rate aligned with literature standards (1%), and patient satisfaction was generally high. A noteworthy observation was a 30% decrease monthly reporting rate and a shift in disease-specific patterns following the COVID-19 outbreak.

Conclusions: Pediatric UEP practices in Italy adhere well to established quality standards. Emphasizing the adoption of disease-specific guidelines is crucial for optimizing resources, enhancing diagnostic accuracy, and minimizing unnecessary procedures. Prioritizing patient satisfaction is important for immediate enhancements in practice as well as for future research endeavors.

Keywords: Nationwide survey; Pediatric endoscopy; Quality improvement; Smartphone. Research.