Dr. Lerner Contributes to National Delphi Consensus on Unsedated Transnasal Endoscopy Competency

Dr. Diana Lerner, Faculty Investigator at WIRE, contributed as a Delphi panelist to a multi-institutional consensus study published in the Journal of Pediatric Gastroenterology and Nutrition that establishes the first validated tool for assessing competence in unsedated transnasal endoscopy (uTNE) in children. The study, led by investigators at Boston Children's Hospital and Harvard Medical School, assembled 27 pediatric uTNE experts from 19 sites across North America to identify the core competencies required for effective and safe TNE performance.

Unsedated transnasal endoscopy is an emerging technique that allows upper endoscopy to be performed without sedation by passing an ultra-thin endoscope through the nose — avoiding the risks, costs, and logistical burden of general anesthesia. Despite growing adoption in pediatric gastroenterology, no validated tool previously existed to assess whether clinicians performing uTNE have achieved competence, creating a gap in training standards and quality assurance.

Using a rigorous Delphi methodology, the expert panel iteratively rated 130 candidate assessment items across three survey rounds until consensus was reached. The final TransNasal Endoscopy Skills Assessment Tool (TNE-SAT) comprises seven core competency items that met the threshold of 80% agreement, providing a structured, video-based framework for evaluating procedural skill. The TNE-SAT offers a scalable approach to training assessment and quality improvement as uTNE continues to expand across pediatric centers.

Dr. Lerner's involvement in this multi-institutional effort underscores the breadth of expertise within the WIRE faculty and the institute's connections to leading pediatric endoscopy programs nationwide.

Citation: Mahoney LB, Lightdale JR, Rubinstein E, et al. Assessing competence in unsedated transnasal endoscopy: Development of the TransNasal Endoscopy Skills Assessment Tool. J Pediatr Gastroenterol Nutr. 2026. https://doi.org/10.1002/jpn3.70323