# Variability in antroduodenal and colonic manometry protocols across pediatric centers worldwide

## TL;DR

This study finds significant differences in how pediatric centers worldwide perform antroduodenal and colonic manometry tests, highlighting the need for standardized protocols.

## Contribution

The study is the first to assess global variability in pediatric antroduodenal and colonic manometry protocols.

## Key findings

- US centers perform more pharmacological stimulations compared to non-US centers.
- Non-US centers conduct longer manometry studies than US centers.
- Most centers use bisacodyl for colonic manometry pharmacological stimulation.

## Abstract

Antroduodenal (ADM) and colonic (CM) manometries are performed in pediatric patients to evaluate gastrointestinal motility disorders. While minimal standards for performing ADM and CM have been published, there are no standardized protocols for performance of these studies.

We aimed to evaluate the diversity in ADM and CM protocols in pediatric centers worldwide.

A cross-sectional study using an anonymous survey was conducted among pediatric centers worldwide comparing US and non-US centers.

Responses were received from 37 pediatric centers. ADM: 17 (45.9%) centers perform next-day and 14 (37.8%) centers perform same-day studies. Study length ranges from 4 to 24 hours. Erythromycin stimulation is implemented by 29/33 (87.9%), azithromycin by 15/33 (45.5%) and octreotide by 7/33 (21.2%) centers. US centers perform more pharmacological stimulations (30/31 (96.8%) vs. 3/6 (50%), p = 0.0018), while non-US centers conduct longer studies (15.3 hours vs. 7.4 hours, p = 0.0291).

CM: 17 (45.9%) centers perform same-day studies with length from 4 to 24 hours, and 89.2% perform pharmacological stimulation, all using bisacodyl.

Significant variability exists in ADM and CM protocols among pediatric centers, affecting study length and pharmacological stimulation. Universal standardized guidelines are needed to ensure uniformity in the performance and interpretation of these studies.

Pediatric gastroenterological societies set minimal standards for antroduodenal (ADM) and colonic (CM) manometry studies, allowing variability in timing, fasting, postprandial phases, and provocation tests.Protocol variability among pediatric centers worldwide has not been previously assessed.This study offers a real-life overview of ADM and CM practices in pediatric centers worldwide, highlighting the need for standardized guidelines due to observed variability in timing, duration, and pharmacologic stimulation.The lack of standardization affects study interpretation and underscores the importance of developing universal guidelines.

Pediatric gastroenterological societies set minimal standards for antroduodenal (ADM) and colonic (CM) manometry studies, allowing variability in timing, fasting, postprandial phases, and provocation tests.

Protocol variability among pediatric centers worldwide has not been previously assessed.

This study offers a real-life overview of ADM and CM practices in pediatric centers worldwide, highlighting the need for standardized guidelines due to observed variability in timing, duration, and pharmacologic stimulation.

The lack of standardization affects study interpretation and underscores the importance of developing universal guidelines.