The Pediatric Therapeutic Endoscopy Program at Children’s Health is a nationally recognized program leading the way in minimally invasive treatments and diagnostics through advanced and therapeutic endoscopy. Dr. David Troendle discusses the program, including ways they are working to improve outcomes and increase access for patients.
For more information about the Pediatric Therapeutic Endoscopy Program and how to refer a patient, visit childrens.com.
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Improving Outcomes with Pediatric Therapeutic Endoscopy
Featured Speaker:
Dr. Troendle has received various awards for clinical research in pediatric endoscopy, including the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition Endoscopy Prize on several occasions.
Learn more about Dr. Troendle
David Troendle, MD
David Troendle, M.D., is the Director of Pediatric Endoscopy at Children’s Health and Associate Professor of Pediatrics at UT Southwestern. Dr. Troendle’s clinical interests are advanced and therapeutic endoscopy in children, including endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS).Dr. Troendle has received various awards for clinical research in pediatric endoscopy, including the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition Endoscopy Prize on several occasions.
Learn more about Dr. Troendle
Transcription:
Improving Outcomes with Pediatric Therapeutic Endoscopy
Dr Hal Altman (Host): Welcome to Pediatric Insights, advances and innovations with Children's Health, where we explore the latest in pediatric care and research. Today, we'll examine the nuances of therapeutic pediatric endoscopy with our guest, Dr. David Troendle. I'm your host, Dr. Hal Altman. The Therapeutic Endoscopy Program at Children's Health is a nationally-recognized program, leading the way in minimally invasive treatments and diagnostics through advanced therapeutic endoscopy. The program is led by Dr. Troendle, a pediatric gastroenterologist at Children's Health and Associate Professor at the University of Texas Southwestern Medical Center.
Today, we're going to talk to Dr. Troendle about the program, including ways that the team is working to improve outcomes and increase access for patients. Dr. Troendle's clinical interests focus on the pediatric application of advanced therapeutic endoscopy, including ERCP and endoscopic ultrasound. Dr. Troendle, it's a pleasure to welcome you to the podcast.
Dr David Troendle: Yeah, thank you for having me.
Dr Hal Altman (Host): Our pleasure. Dr. Troendle, the world of endoscopy along with other minimally invasive procedures is blossoming, offering advanced diagnostic and therapeutic alternatives for older procedures that carry greater risk for the patient. It appears that training in the pediatric application of endoscopy has been difficult because few institutions offer the service. With those challenges in mind, can you tell us about your personal training and about the history of the Pediatric Therapeutic Endoscopy Program at Children's Health and what specific services the program offers?
Dr David Troendle: Sure. I'll start with history of the Therapeutic Endoscopy Program here at children's. I would say the birth of the program started with the recruitment of our current division director, Dr. Bradley Barth, who joined here in Dallas in 2004. And at the time, he had a vision to expand our endoscopic service offerings beyond the traditional diagnostic upper endoscopy and colonoscopy procedures we were already performing. But an obstacle he ran into after arriving here, as you alluded to, was that while adult hospitals had well developed advanced endoscopy programs and training pathways, no such pathways existed for pediatric endoscopists to receive this training. And indeed, there were just a handful of pediatric gastroenterologists doing these procedures in the entire world. Thus, there's no real blueprint from which to build such a program in pediatrics. Fortunately, he was persistent and became appropriately trained by working with adult endoscopists here in town and then was able to bring this expertise back to Children's and, thus, lay the groundwork for what has evolved into a very robust and now world-renowned therapeutic endoscopy program here at Children's.
My interest came into existence when I met Dr. Barth in 2007 as a pediatric resident here, where I saw him doing some procedures that piqued my interest, not only in GI, but endoscopy in particular. And I encountered a lot of the same difficulties he did in terms of identifying training pathways to expand my knowledge base in this area, but like him, was able to open some doors working with some adult endoscopists here in the area. I completed my training and brought some additional expertise over to the hospital to further expand our program.
In terms of offerings, our Therapeutic Endoscopy Program provides our patients and their families unique access to advanced endoscopic techniques, such as ERCP, endoscopic ultrasound, small bowel endoscopy and much more and these techniques allow us to diagnose and treat a variety of conditions, both in and now even outside the gastrointestinal tract.
Dr Hal Altman (Host): Well, thank you for that overview. Specifically, what do you think are the benefits of pediatric endoscopy as compared to more traditional GI care? And what are some of the specific types of patients and conditions that you treat?
Dr David Troendle: So our program allows us to offer treatment options that, as you alluded to, are less invasive than surgery, which typically means faster recovery times, less pain and overall just more cost-effective care. The program also supports other service lines within our hospital system and allows them to be more successful and provide better outcomes for their patients. And some examples of this is we're working closely with our general surgery program, our transplant program, our bariatric surgery program, as well as our oncology program.
In terms of types of patients and conditions we treat, the list is ever-growing, but some of the common conditions we tend to treat are bleeding and narrowings within the GI tract, blockages within the liver and the pancreas. We treat fluid collections, both in the abdomen and in the chest and are often called upon to obtain tissue from mass lesions in difficult-to-reach locations such as those lesions near the heart or the lungs.
Dr Hal Altman (Host): Thank you for that. I think I find it valuable. If we can connect services to a specific case. Is there a specific clinical case that demonstrates how endoscopy can provide a therapeutic advantage in your experience?
Dr David Troendle: Sure. So I can think of several very unique examples. One that stands out to me is a case we managed recently. It was a very small child who had just recently undergone a liver transplantion. And unfortunately, this child developed a blockage at one of the anastomoses made in the bile duct. Now, traditionally, because of the child's small size, this would typically have to be managed with additional surgeries or placing external drains in the patient. But, fortunately, we were able to successfully manage this endoscopically by performing an ERCP, which opened up the blockage. And now, the child's doing great. This was made possible, not only because we had the expertise at our center to perform this procedure, but also because we have access to the unique equipment needed to treat these very small and oftentimes very sick children.
Dr Hal Altman (Host): Thank you for that overview. It absolutely is a case of teamwork improving outcomes. And I know that your endoscopy team has been working to improve outcomes and to reduce the infection threat that comes with GI procedures. Can you comment on that?
Dr David Troendle: Sure. Yeah, this is an extremely important aspect of what we do, and we take this very seriously. We understand that what we are really pushing the envelope of what can be done endoscopically in children and with that comes the responsibility to ensure that our outcomes are excellent. We are very critical of our technical outcomes and monitor them closely. You know, all our cases are reviewed weekly and we discuss them monthly within our division.
We also publish of our outcomes for all to see. And fortunately, our outcomes have been excellent. Maybe I'll cite just three recent examples that come to mind of how we have worked hard to improve our outcomes for our patients. We have been one of the earliest adopters using the recently developed a single-use disposable endoscope for ERCP. By using the single-use disposable scopes, this allows us to essentially eliminate any risk of transmitting infection from patient to patient. We're also pioneering ways to decrease rates of certain adverse events, such as pancreatitis after procedures, such as ERCP. In doing so, we were the first to show that what traditionally works, to do this in adult patients, doesn't work in children, and then we published data on other interventions that seems to work better in children. And also, we have a very robust quality improvement program. And just this past year, we're successful in significantly reducing x-ray exposure during our esophageal dilation procedures. So these are just a few examples, but hopefully illustrate that we are very committed to providing safe and effective endoscopic procedures for our patients and are constantly looking for opportunities to further improve our outcomes as we continue to push what's possible.
Dr Hal Altman (Host): That's very impressive. It's obvious that you have a passion for training other physicians in the art of pediatric endoscopy. Can you tell us more about your training goals and why you think it's important to increase pediatric access to this mode of therapy?
Dr David Troendle: So I like to think that the goals and offerings of our program have really evolved over time as we have gained more experience with these procedures and had success within our program. When we first started our program, we saw our volumes skyrocket two to threefold, as our institution quickly recognized the benefit and the utility of such a program here at Children's. Our hope is that by sharing our experience with others, we can help improve the care provided to children outside of our immediate community as well.
We now see our program is standing on three pillars. Obviously, we are committed to providing excellent patient care to our patients and always looking to advance what we offer as I've already mentioned. But, secondly, we look to share our experience and train the next generation of pediatric advanced endoscopists to go out and offer these procedures elsewhere and continue to advance the field. In addition to training our fellows in advanced endoscopy, we are heavily involved at the national level influencing practice guidelines on the appropriate use of endoscopy in children.
And then lastly, I'd say we feel it is important for us as leaders in the field to advocate for the development of endoscopic equipment and tools that are appropriate for children and specifically designed for the conditions and diseases we see and treat. And as we expand what we do, it becomes essential for industry to meet our needs and we work closely with them to help design tools that will hopefully allow us to be more successful and expand what we're able to offer our patients.
Dr Hal Altman (Host): That is a wonderful overview. And we certainly wish you success in your ongoing training. In closing, Dr. Troendle, could you share the most important thing that you want other providers to know about pediatric therapeutic endoscopy?
Dr David Troendle: Absolutely. So I think we have been able to show that there's an important role for a therapeutic endoscopy program to be embedded within a pediatric hospital, as it can truly benefit patients and supports other service lines in the hospital, allowing them to be more successful. Our program has been fortunate enough to experience great success, and we've learned a lot as we built our program over the last two decades.
Here at Children's, we love talking about endoscopy, all things endoscopy. And I guess the last thing I would say is that we are always happy to collaborate with providers, both within our discipline and within other disciplines to help advance the care we are able to offer our children.
Dr Hal Altman (Host): Well, Dr. Troendle, your passion is infectious and we want to thank you as well as the audience for participating in today's Pediatric Insights, advances and innovations in pediatric therapeutic endoscopy with Children's Health.
Providers can gain more information or refer patients to the Therapeutic Endoscopy Program at Children's Health by visiting the website at www.childrens.com/GIscope. for updates on the latest on pediatric medical advances, breakthroughs and medical research, please follow us on your social channels. You are warmly invited to subscribe, rate, and review this podcast and all other podcasts from Children's Health.
Goodbye and thanks again for listening to Pediatric Insights, advances and innovations with Children's Health.
Improving Outcomes with Pediatric Therapeutic Endoscopy
Dr Hal Altman (Host): Welcome to Pediatric Insights, advances and innovations with Children's Health, where we explore the latest in pediatric care and research. Today, we'll examine the nuances of therapeutic pediatric endoscopy with our guest, Dr. David Troendle. I'm your host, Dr. Hal Altman. The Therapeutic Endoscopy Program at Children's Health is a nationally-recognized program, leading the way in minimally invasive treatments and diagnostics through advanced therapeutic endoscopy. The program is led by Dr. Troendle, a pediatric gastroenterologist at Children's Health and Associate Professor at the University of Texas Southwestern Medical Center.
Today, we're going to talk to Dr. Troendle about the program, including ways that the team is working to improve outcomes and increase access for patients. Dr. Troendle's clinical interests focus on the pediatric application of advanced therapeutic endoscopy, including ERCP and endoscopic ultrasound. Dr. Troendle, it's a pleasure to welcome you to the podcast.
Dr David Troendle: Yeah, thank you for having me.
Dr Hal Altman (Host): Our pleasure. Dr. Troendle, the world of endoscopy along with other minimally invasive procedures is blossoming, offering advanced diagnostic and therapeutic alternatives for older procedures that carry greater risk for the patient. It appears that training in the pediatric application of endoscopy has been difficult because few institutions offer the service. With those challenges in mind, can you tell us about your personal training and about the history of the Pediatric Therapeutic Endoscopy Program at Children's Health and what specific services the program offers?
Dr David Troendle: Sure. I'll start with history of the Therapeutic Endoscopy Program here at children's. I would say the birth of the program started with the recruitment of our current division director, Dr. Bradley Barth, who joined here in Dallas in 2004. And at the time, he had a vision to expand our endoscopic service offerings beyond the traditional diagnostic upper endoscopy and colonoscopy procedures we were already performing. But an obstacle he ran into after arriving here, as you alluded to, was that while adult hospitals had well developed advanced endoscopy programs and training pathways, no such pathways existed for pediatric endoscopists to receive this training. And indeed, there were just a handful of pediatric gastroenterologists doing these procedures in the entire world. Thus, there's no real blueprint from which to build such a program in pediatrics. Fortunately, he was persistent and became appropriately trained by working with adult endoscopists here in town and then was able to bring this expertise back to Children's and, thus, lay the groundwork for what has evolved into a very robust and now world-renowned therapeutic endoscopy program here at Children's.
My interest came into existence when I met Dr. Barth in 2007 as a pediatric resident here, where I saw him doing some procedures that piqued my interest, not only in GI, but endoscopy in particular. And I encountered a lot of the same difficulties he did in terms of identifying training pathways to expand my knowledge base in this area, but like him, was able to open some doors working with some adult endoscopists here in the area. I completed my training and brought some additional expertise over to the hospital to further expand our program.
In terms of offerings, our Therapeutic Endoscopy Program provides our patients and their families unique access to advanced endoscopic techniques, such as ERCP, endoscopic ultrasound, small bowel endoscopy and much more and these techniques allow us to diagnose and treat a variety of conditions, both in and now even outside the gastrointestinal tract.
Dr Hal Altman (Host): Well, thank you for that overview. Specifically, what do you think are the benefits of pediatric endoscopy as compared to more traditional GI care? And what are some of the specific types of patients and conditions that you treat?
Dr David Troendle: So our program allows us to offer treatment options that, as you alluded to, are less invasive than surgery, which typically means faster recovery times, less pain and overall just more cost-effective care. The program also supports other service lines within our hospital system and allows them to be more successful and provide better outcomes for their patients. And some examples of this is we're working closely with our general surgery program, our transplant program, our bariatric surgery program, as well as our oncology program.
In terms of types of patients and conditions we treat, the list is ever-growing, but some of the common conditions we tend to treat are bleeding and narrowings within the GI tract, blockages within the liver and the pancreas. We treat fluid collections, both in the abdomen and in the chest and are often called upon to obtain tissue from mass lesions in difficult-to-reach locations such as those lesions near the heart or the lungs.
Dr Hal Altman (Host): Thank you for that. I think I find it valuable. If we can connect services to a specific case. Is there a specific clinical case that demonstrates how endoscopy can provide a therapeutic advantage in your experience?
Dr David Troendle: Sure. So I can think of several very unique examples. One that stands out to me is a case we managed recently. It was a very small child who had just recently undergone a liver transplantion. And unfortunately, this child developed a blockage at one of the anastomoses made in the bile duct. Now, traditionally, because of the child's small size, this would typically have to be managed with additional surgeries or placing external drains in the patient. But, fortunately, we were able to successfully manage this endoscopically by performing an ERCP, which opened up the blockage. And now, the child's doing great. This was made possible, not only because we had the expertise at our center to perform this procedure, but also because we have access to the unique equipment needed to treat these very small and oftentimes very sick children.
Dr Hal Altman (Host): Thank you for that overview. It absolutely is a case of teamwork improving outcomes. And I know that your endoscopy team has been working to improve outcomes and to reduce the infection threat that comes with GI procedures. Can you comment on that?
Dr David Troendle: Sure. Yeah, this is an extremely important aspect of what we do, and we take this very seriously. We understand that what we are really pushing the envelope of what can be done endoscopically in children and with that comes the responsibility to ensure that our outcomes are excellent. We are very critical of our technical outcomes and monitor them closely. You know, all our cases are reviewed weekly and we discuss them monthly within our division.
We also publish of our outcomes for all to see. And fortunately, our outcomes have been excellent. Maybe I'll cite just three recent examples that come to mind of how we have worked hard to improve our outcomes for our patients. We have been one of the earliest adopters using the recently developed a single-use disposable endoscope for ERCP. By using the single-use disposable scopes, this allows us to essentially eliminate any risk of transmitting infection from patient to patient. We're also pioneering ways to decrease rates of certain adverse events, such as pancreatitis after procedures, such as ERCP. In doing so, we were the first to show that what traditionally works, to do this in adult patients, doesn't work in children, and then we published data on other interventions that seems to work better in children. And also, we have a very robust quality improvement program. And just this past year, we're successful in significantly reducing x-ray exposure during our esophageal dilation procedures. So these are just a few examples, but hopefully illustrate that we are very committed to providing safe and effective endoscopic procedures for our patients and are constantly looking for opportunities to further improve our outcomes as we continue to push what's possible.
Dr Hal Altman (Host): That's very impressive. It's obvious that you have a passion for training other physicians in the art of pediatric endoscopy. Can you tell us more about your training goals and why you think it's important to increase pediatric access to this mode of therapy?
Dr David Troendle: So I like to think that the goals and offerings of our program have really evolved over time as we have gained more experience with these procedures and had success within our program. When we first started our program, we saw our volumes skyrocket two to threefold, as our institution quickly recognized the benefit and the utility of such a program here at Children's. Our hope is that by sharing our experience with others, we can help improve the care provided to children outside of our immediate community as well.
We now see our program is standing on three pillars. Obviously, we are committed to providing excellent patient care to our patients and always looking to advance what we offer as I've already mentioned. But, secondly, we look to share our experience and train the next generation of pediatric advanced endoscopists to go out and offer these procedures elsewhere and continue to advance the field. In addition to training our fellows in advanced endoscopy, we are heavily involved at the national level influencing practice guidelines on the appropriate use of endoscopy in children.
And then lastly, I'd say we feel it is important for us as leaders in the field to advocate for the development of endoscopic equipment and tools that are appropriate for children and specifically designed for the conditions and diseases we see and treat. And as we expand what we do, it becomes essential for industry to meet our needs and we work closely with them to help design tools that will hopefully allow us to be more successful and expand what we're able to offer our patients.
Dr Hal Altman (Host): That is a wonderful overview. And we certainly wish you success in your ongoing training. In closing, Dr. Troendle, could you share the most important thing that you want other providers to know about pediatric therapeutic endoscopy?
Dr David Troendle: Absolutely. So I think we have been able to show that there's an important role for a therapeutic endoscopy program to be embedded within a pediatric hospital, as it can truly benefit patients and supports other service lines in the hospital, allowing them to be more successful. Our program has been fortunate enough to experience great success, and we've learned a lot as we built our program over the last two decades.
Here at Children's, we love talking about endoscopy, all things endoscopy. And I guess the last thing I would say is that we are always happy to collaborate with providers, both within our discipline and within other disciplines to help advance the care we are able to offer our children.
Dr Hal Altman (Host): Well, Dr. Troendle, your passion is infectious and we want to thank you as well as the audience for participating in today's Pediatric Insights, advances and innovations in pediatric therapeutic endoscopy with Children's Health.
Providers can gain more information or refer patients to the Therapeutic Endoscopy Program at Children's Health by visiting the website at www.childrens.com/GIscope. for updates on the latest on pediatric medical advances, breakthroughs and medical research, please follow us on your social channels. You are warmly invited to subscribe, rate, and review this podcast and all other podcasts from Children's Health.
Goodbye and thanks again for listening to Pediatric Insights, advances and innovations with Children's Health.