Consensus on Triple Endoscopy Data Elements Preparatory to Development of an Aerodigestive Registry

Abstract

Objectives/Hypothesis: This study defines essential data elements to be recorded during an aerodigestive "triple endoscopy" to form the foundation of a standardized multicenter registry and to clearly define measurement of each consensus item.Study Design: Modified Delphi process.Methods: Modified Delphi consensus with six survey rounds. Twenty-four expert pediatric otolaryngology, pulmonology, and gastroenterology aerodigestive clinicians from eight large academic pediatric aerodigestive programs formed the Delphi panel. After achieving consensus through the Delphi process, outside validation was performed at 2019 national Aerodigestive Society conference. Consensus, near-consensus, or exclusion was obtained for each proposed data element. Concordance was then measured between expert panel conclusions and validation group conclusions.Results: Overall response rate was 94.4%. 73/167 proposed items reached consensus in six domains (flexible bronchoscopy, bronchoalveolar lavage, microdirect laryngoscopy and bronchoscopy, esophagogastroduodenoscopy with biopsies, and esophageal impedance and pH probe). Measurement of all items was defined; classification/grading systems were selected for 11 items. Validation group endorsed importance of 82/167 data items; compared to expert consensus, overall, inclusion, and exclusion concordance rates were 94.5%, 98.7%, and 90.9%. Conclusion:Triple endoscopy is a central component of aerodigestive care. This study identifies and defines data elements to be recorded for all triple endoscopy procedures. The list is of usable length, and clear definitions were created for all items, with explicit classification/grading systems selected for 11 items. Face validity was confirmed with an independent multispecialty sample of aerodigestive providers. This consensus provides the foundation for a triple endoscopy registry but also is immediately applicable to standardize clinical documentation in aerodigestive care.

Gastrointestinal factors associated with risk of bronchiectasis in children

“…With the growth of multidisciplinary aerodigestive centers, many patients with persistent pulmonary symptoms undergo triple airway endoscopy as an initial part of their workup before consideration of chest CT. 49 This approach commonly includes flexible bronchoscopy with bronchoalveolar lavage and the results are typically interpreted in the multidisciplinary aerodigestive context. 8,[12][13][14] Prior studies have shown an association between bronchiectasis and BAL neutrophil count and the results our ROC analysis are similar.…”

Anesthesia for laryngotracheal reconstruction in children: A narrative review

“…1,14 Prior to airway surgery, a triple endoscopy including microlaryngoscopy and bronchoscopy (MLB), upper gastrointestinal endoscopy, and flexible bronchoscopy is commonly performed. 15 MLB remains the gold standard for the diagnosis, quantification, and LTS treatment planning.…”

“…Many children with SGS have additional comorbidities that require multidisciplinary consultation with pediatric surgery, cardiology, cardiothoracic surgery, genetics, neurology, and neurosurgery 1,14 . Prior to airway surgery, a triple endoscopy including microlaryngoscopy and bronchoscopy (MLB), upper gastrointestinal endoscopy, and flexible bronchoscopy is commonly performed 15 . MLB remains the gold standard for the diagnosis, quantification, and LTS treatment planning.…”

Making the case for multidisciplinary pediatric aerodigestive programs

“…This allows for complementary modalities for evaluation of upper GI and airway structures and dynamics and facilitates real-time discovery, discussion, and planning amongst all the specialists involved, allowing for excellent, patient-centric care. A consensus on the core data elements to be gathered during triple endoscopy has been published[ 17 ]. From the gastroenterology standpoint, the importance of assessing for EoE is highlighted due to potential contribution to aerodigestive symptoms.…”