Background <p>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.</p> <p>We aimed to evaluate the diversity in ADM and CM protocols in pediatric centers worldwide.</p> Methods <p>A cross-sectional study using an anonymous survey was conducted among pediatric centers worldwide comparing US and non-US centers.</p> Results <p>Responses were received from 37 pediatric centers. <Emphasis Type="Underline">ADM</Emphasis>: 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%), <i>p</i> = 0.0018), while non-US centers conduct longer studies (15.3 hours vs. 7.4 hours, <i>p</i> = 0.0291).</p> <p><Emphasis Type="Underline">CM:</Emphasis> 17 (45.9%) centers perform same-day studies with length from 4 to 24 hours, and 89.2% perform pharmacological stimulation, all using bisacodyl.</p> Conclusions <p>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.</p> Impact <p><UnorderedList Mark="Bullet"> <ItemContent> <p>Pediatric gastroenterological societies set minimal standards for antroduodenal (ADM) and colonic (CM) manometry studies, allowing variability in timing, fasting, postprandial phases, and provocation tests.</p> </ItemContent> <ItemContent> <p>Protocol variability among pediatric centers worldwide has not been previously assessed.</p> </ItemContent> <ItemContent> <p>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.</p> </ItemContent> <ItemContent> <p>The lack of standardization affects study interpretation and underscores the importance of developing universal guidelines.</p> </ItemContent> </UnorderedList></p>