TY - JOUR
T1 - Adherence to Quality Indicators for Diagnosis and Surveillance of Barrett's Esophagus
T2 - A Comparative Study of Barrett's Experts and Nonexperts
AU - Farina, Domenico A.
AU - Beveridge, Claire A.
AU - Kia, Leila
AU - Gray, Elizabeth
AU - Komanduri, Srinadh
N1 - Funding Information:
Conflicts of Interest These authors disclose the following: L.K.: Educational grant, Impleo; S.K.: Consultant, Medtronic; Consultant, Boston Scientific; Consultant, Cook Medical; Consultant, Olympus Corp; Consultant, GI Supply; Educational grant, Boston Scientific. The remaining authors disclose no conflicts. S.K. is a member of the Board of Editors. Their paper was handled in accordance with our conflict of interest policy. See https://www.tigejournal.org/content/authorinfo#coi for full details. Funding None.
Publisher Copyright:
© 2023 Elsevier Inc.
PY - 2023/1
Y1 - 2023/1
N2 - Background and Aims: There is considerable variability in adherence to endoscopic quality indicators (QIs) for Barrett's esophagus (BE). The aims of this study were to (1) assess adherence to published Qis for diagnosis and surveillance of BE, (2) compare adherence between BE experts and nonexperts, and (3) identify factors associated with adherence. Methods: We identified all patients with BE on esophagogastroduodenoscopy between 2010 and 2018. QIs evaluated included inspection using high-definition white light endoscopy, use of the Prague Classification, identification of endoscopic landmarks, use of the Seattle Protocol, and guideline-adherent recommendations for surveillance or endoscopic eradication therapy. BE experts and nonexperts were compared using logistic mixed-effects models. Results: A total of 467 patients were identified, with BE experts performing fewer overall esophagogastroduodenoscopies (n = 162, 34.7% vs n = 305, 65.3%). Whereas BE experts were more likely to document Prague Classification (52.5% vs 41.3%; P = 0.017) and landmarks (43.2% vs 22.6%; P = 0.036), there was no significant difference between experts and nonexperts in use of high-definition white light endoscopy (8.6% vs 3.3%; P = 0.123), Seattle Protocol (48.1% vs 40.3%; P = 0.313), or guideline-adherent surveillance or treatment recommendations (71.0% vs 67.5%; P = 0.509). Patient enrollment in a BE surveillance program was the only factor associated with improved QI adherence, specifically adherence to Prague Classification documentation (OR 1.85, 95% CI 1.08-3.14; P = 0.025), Seattle Protocol (1.28, 95% CI 1.16-1.50; P < 0.001), and follow-up recommendations (OR 2.64, 95% CI 1.55-4.48; P < 0.001). Conclusion: Patterns of adherence to published QIs for endoscopy in patients with BE are mostly independent of expertise. Further training initiatives are needed to standardize the performance of endoscopic practice in patients with BE.
AB - Background and Aims: There is considerable variability in adherence to endoscopic quality indicators (QIs) for Barrett's esophagus (BE). The aims of this study were to (1) assess adherence to published Qis for diagnosis and surveillance of BE, (2) compare adherence between BE experts and nonexperts, and (3) identify factors associated with adherence. Methods: We identified all patients with BE on esophagogastroduodenoscopy between 2010 and 2018. QIs evaluated included inspection using high-definition white light endoscopy, use of the Prague Classification, identification of endoscopic landmarks, use of the Seattle Protocol, and guideline-adherent recommendations for surveillance or endoscopic eradication therapy. BE experts and nonexperts were compared using logistic mixed-effects models. Results: A total of 467 patients were identified, with BE experts performing fewer overall esophagogastroduodenoscopies (n = 162, 34.7% vs n = 305, 65.3%). Whereas BE experts were more likely to document Prague Classification (52.5% vs 41.3%; P = 0.017) and landmarks (43.2% vs 22.6%; P = 0.036), there was no significant difference between experts and nonexperts in use of high-definition white light endoscopy (8.6% vs 3.3%; P = 0.123), Seattle Protocol (48.1% vs 40.3%; P = 0.313), or guideline-adherent surveillance or treatment recommendations (71.0% vs 67.5%; P = 0.509). Patient enrollment in a BE surveillance program was the only factor associated with improved QI adherence, specifically adherence to Prague Classification documentation (OR 1.85, 95% CI 1.08-3.14; P = 0.025), Seattle Protocol (1.28, 95% CI 1.16-1.50; P < 0.001), and follow-up recommendations (OR 2.64, 95% CI 1.55-4.48; P < 0.001). Conclusion: Patterns of adherence to published QIs for endoscopy in patients with BE are mostly independent of expertise. Further training initiatives are needed to standardize the performance of endoscopic practice in patients with BE.
KW - Adherence
KW - Barrett's esophagus
KW - Endoscopic eradication therapy
KW - Guidelines
KW - Quality indicators
UR - http://www.scopus.com/inward/record.url?scp=85160345268&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85160345268&partnerID=8YFLogxK
U2 - 10.1016/j.tige.2023.02.008
DO - 10.1016/j.tige.2023.02.008
M3 - Article
AN - SCOPUS:85160345268
SN - 2666-5107
VL - 25
SP - 204
EP - 212
JO - Techniques and Innovations in Gastrointestinal Endoscopy
JF - Techniques and Innovations in Gastrointestinal Endoscopy
IS - 3
ER -