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CC BY 4.0 · Endosc Int Open 2025; 13: a25922914
DOI: 10.1055/a-2592-2914
Original article

Mobile health technology in quality assessment of pediatric ileocolonoscopy: Results of the SIGENP national program

Salvatore Oliva
1   Pediatric Gastroenterology and Liver Unit, Maternal and Child Health Department, Sapienza University of Rome, Rome, Italy
,
Giusy Russo
1   Pediatric Gastroenterology and Liver Unit, Maternal and Child Health Department, Sapienza University of Rome, Rome, Italy
,
Lucia Cococcioni
2   Department of Pediatrics, Vittore Buzzi Children's Hospital, Milano, Italy (Ringgold ID: RIN37220)
,
Francesca Destro
3   Department of Pediatric Surgery, Vittore Buzzi Children's Hospital, Milano, Italy (Ringgold ID: RIN37220)
,
Marco Deganello Saccomani 
4   Department of Pediatrics, Woman’s and Child’s University Hospital of Verona, Verona, Italy
,
Claudia Banzato
4   Department of Pediatrics, Woman’s and Child’s University Hospital of Verona, Verona, Italy
,
Barbara Parma
5   Department of Pediatrics, Mariani Foundation Center for Fragile Child, ASST-Lariana, Sant'Anna Hospital, San Fermo della Battaglia, Italy
,
Giulia Franchino
5   Department of Pediatrics, Mariani Foundation Center for Fragile Child, ASST-Lariana, Sant'Anna Hospital, San Fermo della Battaglia, Italy
,
Giovanni Di Nardo
6   NESMOS Department, University of Rome La Sapienza, Rome, Italy (Ringgold ID: RIN9311)
,
Emanuele Nicastro
7   Pediatric Hepatology Gastrosenterology and Transplantation Unit, ASST Papa Giovanni XXIII, Bergamo, Italy (Ringgold ID: RIN9333)
,
Paolo Orizio
8   Department of Pediatric Surgery, Spedali Civili Children's Hospital, Brescia, Italy
,
Emanuele Dabizzi
9   Gastroenterology and Interventional Endoscopy Unit, Surgical Department, AUSL di Bologna, Bologna, Italy (Ringgold ID: RIN26217)
,
Giorgio Raffaele Fava
10   Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy (Ringgold ID: RIN9339)
,
Andrea Chiaro
11   Pediatric Gastroenterology and Endoscopy Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy (Ringgold ID: RIN18572)
,
Maristella Pellegrino
12   Pediatric Surgery Department, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy (Ringgold ID: RIN9338)
,
Fabiola Fornaroli
13   Gastroenterology and Endoscopy Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy (Ringgold ID: RIN9370)
,
Antonio Pizzol
14   Pediatric Gastroenterology Unit, Regina Margherita Children's Hospital, Turin, Italy (Ringgold ID: RIN472627)
,
Caterina Strisciuglio
15   Department of Woman, Child, General and Specialistic Surgery, University of Campania Luigi Vanvitelli School of Medicine and Surgery, Napoli, Italy (Ringgold ID: RIN507855)
,
Caterina Pacenza
16   Department of Pediatrics, San Giovanni di Dio Hospital, Crotone, Italy
,
Sara Renzo
17   Gastroenterology and Nutrition Unit, Meyer Children’s Hospital, Florence, Italy
,
Cosimo Ruggiero
1   Pediatric Gastroenterology and Liver Unit, Maternal and Child Health Department, Sapienza University of Rome, Rome, Italy
,
Francesco Morotti
18   Division of Pediatrics, Department of Health Sciences, Università degli Studi del Piemonte Orientale Amedeo Avogadro Facoltà di Medicina e Chirurgia, Novara, Italy (Ringgold ID: RIN60252)
19   Neonatology and Neonatal Intensive Care Unit, Spedali Civili Children's Hospital, Brescia, Italy
,
Lorenzo Norsa 
20   Pediatric Hepatology Gastroenterology and Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy (Ringgold ID: RIN9333)
21   Department of Pediatrics, Vittore Buzzi Children's Hospital, Vittore Buzzi Children's Hospital, Milano, Italy (Ringgold ID: RIN37220)
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Abstract

Background and study aims

Currently, there is no formal quality assessment of pediatric gastrointestinal endoscopy. We innovatively used mobile health (mHealth) technology to determine the quality of pediatric ileocolonoscopy (IC) in Italy.

Methods

Between April 2019 and March 2021, we prospectively collected data (demographics, procedure information, pre/intra/post-procedure indicators, patient satisfaction questionnaires) from the Italian Society of Pediatric Gastroenterology, Hepatology, and Nutrition using the ENDO-PED mobile app.

Results

Of 3410 registered procedures, 827 ICs were analyzed. Mean patient age was 11.1 ± 4.7 years. The most frequent indication was IBD follow-up or diagnosis (57.9%). Therapeutic ICs accounted for 11%, with polypectomy being the most common procedure. Among pre-procedure indicators, waiting time < 30 days was reported in 70.7%, informed consent was signed in 99.8% of cases, and 90.8% of patients completed > 90% of bowel preparation. In terms of intra-procedure indicators, deep sedation was the most commonly used method (77.8%). A high level of bowel cleansing was achieved in 87.4% of patients, with a terminal ileal (TI) intubation rate of 91.6%. Mean IC time with and without TI intubation was 24.2 ± 15.5 and 22.6 ± 15.6 minutes, respectively (P=0.2). Regarding post-procedure indicators, late complications occurred in three children (0.4%), and a final report was issued in 96% of cases, with 67.2% being completed after more than 15 days.

Conclusions

mHealth was effective in assessing the quality of pediatric endoscopy. Levels of bowel preparation, sedation, TI intubation rate, and safety were adequate in Italy, whereas waiting time and post-procedure communication seemed to be the most critical areas of concern.

Keywords

Quality and logistical aspects - Quality management - Endoscopy Lower GI Tract - Pediatric endoscopy


Publication History

Received: 02 October 2024

Accepted after revision: 14 March 2025

Accepted Manuscript online:
22 April 2025

Article published online:
17 June 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

Bibliographical Record
Salvatore Oliva, Giusy Russo, Lucia Cococcioni, Francesca Destro, Marco Deganello Saccomani, Claudia Banzato, Barbara Parma, Giulia Franchino, Giovanni Di Nardo, Emanuele Nicastro, Paolo Orizio, Emanuele Dabizzi, Giorgio Raffaele Fava, Andrea Chiaro, Maristella Pellegrino, Fabiola Fornaroli, Antonio Pizzol, Caterina Strisciuglio, Caterina Pacenza, Sara Renzo, Cosimo Ruggiero, Francesco Morotti, Lorenzo Norsa. Mobile health technology in quality assessment of pediatric ileocolonoscopy: Results of the SIGENP national program. Endosc Int Open 2025; 13: a25922914.
DOI: 10.1055/a-2592-2914
 

  • References

  • 1 Chassin MR, Loeb JM, Schmaltz SP. et al. Accountability measures--using measurement to promote quality improvement. N Engl J Med 2010; 363: 683-688
    Search in Google Scholar
  • 2 Petersen BT. Quality assurance for endoscopists. Best Pract Res Clin Gastroenterol 2011; 25: 349-360
    Search in Google Scholar
  • 3 Armstrong D. Quality indicators for colonoscopy: The road forward. Can J Gastroenterol Hepatol 2014; 28: 242
    Search in Google Scholar
  • 4 Rex DK, Schoenfeld PS, Cohen J. et al. Quality indicators for colonoscopy. Gastrointest Endosc 2015; 81: 31-53
    Search in Google Scholar
  • 5 Kaminski MF, Thomas-Gibson S, Bugajski M. et al. Performance measures for lower gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. Endoscopy 2017; 49: 378-397
    Search in Google Scholar
  • 6 Valori R, Cortas G, de Lange T. et al. Performance measures for endoscopy services: A European Society of Gastrointestinal Endoscopy (ESGE) quality improvement initiative. United European Gastroenterol J 2019; 7: 21-44
    Search in Google Scholar
  • 7 Bisschops R, Rutter MD, Areia M. et al. Overcoming the barriers to dissemination and implementation of quality measures for gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) and United European Gastroenterology (UEG) position statement. United European Gastroenterol J 2021; 9: 120-126
    Search in Google Scholar
  • 8 Rembacken B, Hassan C, Riemann JF. et al. Quality in screening colonoscopy: position statement of the European Society of Gastrointestinal Endoscopy (ESGE). Endoscopy 2012; 44: 957-968
    Search in Google Scholar
  • 9 Forget S, Walsh C. Pediatric endoscopy: need for a tailored approach to guidelines on quality and safety. Can J Gastroenterol 2012; 26: 735
    Search in Google Scholar
  • 10 Lightdale JR. Measuring quality in pediatric endoscopy. Gastrointest Endosc Clin N Am 2016; 26: 47-62
    Search in Google Scholar
  • 11 Lightdale JR, Walsh CM, Oliva S. et al. Pediatric Endoscopy Quality Improvement Network Quality Standards and Indicators for Pediatric Endoscopic Procedures: A Joint NASPGHAN/ESPGHAN Guideline. J Pediatr Gastroenterol Nutr 2022; 74: S30-S43
    Search in Google Scholar
  • 12 Kramer RE, Walsh CM, Lerner DG. et al. Quality improvement in pediatric endoscopy: A clinical report from the NASPGHAN Endoscopy Committee. J Pediatr Gastroenterol Nutr 2017; 65: 125-131
    Search in Google Scholar
  • 13 Walsh CM, Lightdale JR, Mack DR. et al. Overview of the Pediatric Endoscopy Quality Improvement Network Quality Standards and Indicators for Pediatric Endoscopy: A Joint NASPGHAN/ESPGHAN Guideline. J Pediatr Gastroenterol Nutr 2022; 74: S3-S15
    Search in Google Scholar
  • 14 Lightdale JR, Walsh CM, Narula P. et al. Pediatric Endoscopy Quality Improvement Network Quality Standards and Indicators for Pediatric Endoscopy Facilities: A Joint NASPGHAN/ESPGHAN Guideline. J Pediatr Gastroenterol Nutr 2022; 74: S16-S29
    Search in Google Scholar
  • 15 Walsh CM, Lightdale JR, Leibowitz IH. et al. Pediatric Endoscopy Quality Improvement Network Quality Standards and Indicators for Pediatric Endoscopists and Endoscopists in Training: A Joint NASPGHAN/ESPGHAN Guideline. J Pediatr Gastroenterol Nutr 2022; 74: S44-S52
    Search in Google Scholar
  • 16 Walsh CM, Lightdale JR, Fishman DS. et al. Pediatric Endoscopy Quality Improvement Network Pediatric Endoscopy Reporting Elements: A Joint NASPGHAN/ESPGHAN Guideline. J Pediatr Gastroenterol Nutr 2022; 74: S53-S62
    Search in Google Scholar
  • 17 Fleischmann R, Decker AM, Kraft A. et al. Mobile electronic versus paper case report forms in clinical trials: a randomized controlled trial. BMC Med Res Methodol 2017; 17: 153
    Search in Google Scholar
  • 18 Dorsey ER, Chan Y-FY, McConnell MV. et al. The use of smartphones for health research. Acad Med 2017; 92: 157-160
    Search in Google Scholar
  • 19 Silva BM, Rodrigues JJ, de la Torre I Díez. et al. Mobile-health: A review of current state in 2015. J Biomed Inform 2015; 56: 265-272
    Search in Google Scholar
  • 20 Atherley A, Hu W, Teunissen PW. et al. Appraising the use of smartphones and apps when conducting qualitative medical education research: AMEE Guide No. 130. Med Teach 2021; 43: 68-74
    Search in Google Scholar
  • 21 Norsa L, Morotti F, Mantegazza C. et al. 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;
    Search in Google Scholar
  • 22 Lai EJ, Calderwood AH, Doros G. et al. The Boston bowel preparation scale: a valid and reliable instrument for colonoscopy-oriented research. Gastrointest Endosc 2009; 69: 620-625
    Search in Google Scholar
  • 23 Tringali A, Thomson M, Dumonceau JM. et al. Pediatric gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) and European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) Guideline Executive summary. Endoscopy 2017; 49: 83-91
    Search in Google Scholar
  • 24 Oliva S, Thomson M, de Ridder L. et al. Endoscopy in pediatric inflammatory bowel disease: a position paper on behalf of the Porto IBD Group of the European Society for Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr 2018; 67: 414-430
    Search in Google Scholar
  • 25 Renzo S, Scarallo L, Antoniello LM. et al. Impact of COVID-19 pandemic on pediatric endoscopy: A multicenter study on behalf of the SIGENP Endoscopy Working Group. Dig Liver Dis 2022; 54: 572-579
    Search in Google Scholar
  • 26 Athiana I, Légeret C, Bontems P. et al. Significant variations across European centres in implementing recommended guidelines for the paediatric gastroenterology endoscopy suite during the COVID-19 pandemic. JPGN Rep 2021; 2: e061
    Search in Google Scholar
  • 27 Garfan S, Alamoodi AH, Zaidan BB. et al. Telehealth utilization during the Covid-19 pandemic: A systematic review. Comput Biol Med 2021; 138: 104878
    Search in Google Scholar
  • 28 Huang JS, Walsh CM. Electronic medical records: Use as tools for improving quality in pediatric endoscopy. Gastrointest Endosc Clin N Am 2023; 33: 267-290
    Search in Google Scholar
  • 29 Thakkar K, Holub JL, Gilger MA. et al. Quality indicators for pediatric colonoscopy: results from a multicenter consortium. Gastrointest Endosc 2016; 83: 533-541
    Search in Google Scholar
  • 30 Singh HK, Withers GD, Ee LC. Quality indicators in pediatric colonoscopy: an Australian tertiary center experience. Scand J Gastroenterol 2017; 52: 1453-1456
    Search in Google Scholar
  • 31 Thomson M, Eltumi M, Singh C. et al. Sub-10-minute high-quality diagnostic colonoscopy with terminal ileum intubation in children is feasible and safe. J Pediatr Gastroenterol Nutr 2019; 69: 6-12
    Search in Google Scholar
  • 32 Pasquarella CS, Kaplan B, Mahajan L. et al. A single-center review of pediatric colonoscopy quality indicators. J Pediatr Gastroenterol Nutr 2019; 68: 648-654
    Search in Google Scholar
  • 33 Lee WS, Tee CW, Koay ZL. et al. Quality indicators in pediatric colonoscopy in a low-volume center: Implications for training. World J Gastroenterol 2018; 24: 1013-1021
    Search in Google Scholar
  • 34 Thomson M, Tringali A, Dumonceau JM. et al. Paediatric gastrointestinal endoscopy: European Society for Paediatric Gastroenterology Hepatology and Nutrition and European Society of Gastrointestinal Endoscopy guidelines. J Pediatr Gastroenterol Nutr 2017; 64: 133-153
    Search in Google Scholar
  • 35 Hassan C, East J, Radaelli F. et al. Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2019. Endoscopy 2019; 51: 775-794
    Search in Google Scholar
  • 36 Alaifan M, Barker C. Colonoscopy quality assurance and maintenance of competency among pediatric gastroenterology staff members: A Canadian center experience. Cureus 2022; 14: e26126
    Search in Google Scholar
  • 37 Mahoney LB, Lightdale JR. The evolution of sedation for pediatric gastrointestinal endoscopy. Gastrointest Endosc Clin N Am 2023; 33: 213-234
    Search in Google Scholar
  • 38 Hartjes KT, Dafonte TM, Lee AF. et al. Variation in pediatric anesthesiologist sedation practices for pediatric gastrointestinal endoscopy. Front Pediatr 2021; 9: 709433
    Search in Google Scholar
  • 39 Early DS, Lightdale JR, Vargo 2nd JJ. et al. Guidelines for sedation and anesthesia in GI endoscopy. Gastrointest Endosc 2018; 87: 327-337
    Search in Google Scholar
  • 40 Deganello Saccomani M, Norsa L, Oliva S. et al. The pediatric endoscopy practice in Italy: A nationwide survey on behalf of the Italian society of pediatric gastroenterology, hepatology and nutrition (SIGENP). Dig Liver Dis 2019; 51: 1203-1206
    Search in Google Scholar