Su1759 The Management of Patients Requiring ERCP At Pediatric Centers: a US Survey

Abstract

Su1759 The Management of Patients Requiring ERCP At Pediatric Centers: a US Survey David Troendle*, Douglas S. Fishman, Victor L. Fox, Bradley a. Barth UT Southwestern Medical Center, Dallas, TX; Children’s Medical Center Dallas, Dallas, TX; Texas Children’s Hospital, Houston, TX; Baylor College of Medicine, Houston, TX; Boston Children’s Hospital, Boston, MA Background: Single center experiences have demonstrated the safety and efficacy of endoscopic retrograde cholangiopancreatography (ERCP) in the pediatric population. As we seek to optimize care delivery as well as technical and clinical outcomes in pediatric ERCP, it is important to understand how and where pediatric patients are ultimately receiving care. The goal of this research is to describe how children requiring ERCP are triaged and managed at pediatric centers in the United States. Methods: Following IRB approval, A REDCaps survey was administered to 68 pediatric gastroenterologists who have described themselves as managers of endoscopy operations for their academic or private practice according to a national endoscopy register. The survey inquired about the annual volume of patients requiring ERCP, where ERCP was being performed (adult center or pediatric center), who was performing the procedure (pediatric gastroenterologist pedGE or adult gastroenterologist adultGE), and were patients being transferred to receive their care. Additional questions were asked to see how these trends might change in the near future. Results: Thirty-two (47%) of 68 surveyed centers responded to the survey. Nine of 32 (28%) respondents stated that greater than 40 patients requiring ERCP were encountered annually at their center. No center reported more than 100 patients per year requiring ERCP. Twelve (38%) stated a pediatric gastroenterologist was performing ERCP at that center for some or all indications, 14 (44%) had adult endoscopists performing all ERCPs without the patient being transferred, and 6 (19%) transferred the patient to another institution for ERCP. In total, respondents reported 771-1145 ERCPs being performed annually on pediatric patients with 125200 patients being transferred to another institution before receiving definitive care. Table 1 shows the frequency with which various operating environments were utilized in pediatric ERCP. Six of the 20 (30%) centers without a pediatric gastroenterologist ERCPist were actively seeking a pediatric trained gastroenterologist capable of performing ERCP. Three pediatric centers are currently attempting to train pediatric gastroenterologist to perform ERCP independently. Conclusions: According to survey respondents, most pediatric ERCPs are being performed within the setting of a pediatric center by pediatric gastroenterologist, although there is variability. Over 15% of patients are transferred to another institution before definitive care is received. Several centers appear to be recruiting pediatric gastroenterologists to perform ERCP at their facility.