Over-Utilization of Repeat Upper Endoscopy in Patients with Non-dysplastic Barrett's Esophagus: A Quality Registry Study

Sachin Wani, J. Lucas Williams, Srinadh Komanduri, V. Raman Muthusamy, Nicholas J. Shaheen

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

INTRODUCTION: Guidelines recommend that patients with non-dysplastic Barrett's esophagus (NDBE) undergo surveillance endoscopy every 3-5 years. Using a national registry, we assessed compliance to recommended surveillance intervals in patients with NDBE and identified factors associated with compliance. METHODS: We analyzed data from the GI Quality Improvement Consortium registry. Data abstracted include procedure indication, demographics, endoscopy/pathology results, and recommendations for future endoscopy. Patients with an indication of Barrett's esophagus (BE) screening or surveillance, or an endoscopic finding of BE, with non-dysplastic intestinal metaplasia on pathological examination, were included. Compliance was defined as a recommendation to undergo subsequent endoscopy between 3 and 5 years. Multivariate logistic regression was conducted to assess variables associated with compliance. RESULTS: Of 786,712 endoscopies assessed, 58,709 (7.5%) endoscopies in 53,541 patients met inclusion criteria (mean age 61.3 years, 60.4% men, 90.2% white, mean BE length was 2.3 cm). Most cases were performed by Gastroenterologists (92.3%) with propofol (78.7%). A total of 29,978 procedures (55.8%) resulted in pathology-confirmed BE. Among procedures with NDBE (n = 25,945), 29.9% were noncompliant with the 3-year threshold; most (26.9%) recommended surveillance at 1- to 2-year intervals. Patient factors such as extremes of age, black race, geographic region, type of sedation, and increasing BE length were associated with noncompliance. DISCUSSION: Approximately 30% of patients with NDBE are recommended to undergo surveillance endoscopy too soon. Patient factors associated with inappropriate utilization include extremes of age, black race, and increasing BE length. Compliance with appropriate endoscopic follow-up as a quality measure in BE is poor.

Original languageEnglish (US)
Pages (from-to)1256-1264
Number of pages9
JournalThe American journal of gastroenterology
Volume114
Issue number8
DOIs
StatePublished - Aug 1 2019

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Barrett Esophagus
Endoscopy
Registries
Compliance
Pathology
Metaplasia
Propofol
Quality Improvement
Logistic Models
Demography
Guidelines

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Wani, Sachin ; Williams, J. Lucas ; Komanduri, Srinadh ; Muthusamy, V. Raman ; Shaheen, Nicholas J. / Over-Utilization of Repeat Upper Endoscopy in Patients with Non-dysplastic Barrett's Esophagus : A Quality Registry Study. In: The American journal of gastroenterology. 2019 ; Vol. 114, No. 8. pp. 1256-1264.
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abstract = "INTRODUCTION: Guidelines recommend that patients with non-dysplastic Barrett's esophagus (NDBE) undergo surveillance endoscopy every 3-5 years. Using a national registry, we assessed compliance to recommended surveillance intervals in patients with NDBE and identified factors associated with compliance. METHODS: We analyzed data from the GI Quality Improvement Consortium registry. Data abstracted include procedure indication, demographics, endoscopy/pathology results, and recommendations for future endoscopy. Patients with an indication of Barrett's esophagus (BE) screening or surveillance, or an endoscopic finding of BE, with non-dysplastic intestinal metaplasia on pathological examination, were included. Compliance was defined as a recommendation to undergo subsequent endoscopy between 3 and 5 years. Multivariate logistic regression was conducted to assess variables associated with compliance. RESULTS: Of 786,712 endoscopies assessed, 58,709 (7.5{\%}) endoscopies in 53,541 patients met inclusion criteria (mean age 61.3 years, 60.4{\%} men, 90.2{\%} white, mean BE length was 2.3 cm). Most cases were performed by Gastroenterologists (92.3{\%}) with propofol (78.7{\%}). A total of 29,978 procedures (55.8{\%}) resulted in pathology-confirmed BE. Among procedures with NDBE (n = 25,945), 29.9{\%} were noncompliant with the 3-year threshold; most (26.9{\%}) recommended surveillance at 1- to 2-year intervals. Patient factors such as extremes of age, black race, geographic region, type of sedation, and increasing BE length were associated with noncompliance. DISCUSSION: Approximately 30{\%} of patients with NDBE are recommended to undergo surveillance endoscopy too soon. Patient factors associated with inappropriate utilization include extremes of age, black race, and increasing BE length. Compliance with appropriate endoscopic follow-up as a quality measure in BE is poor.",
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Over-Utilization of Repeat Upper Endoscopy in Patients with Non-dysplastic Barrett's Esophagus : A Quality Registry Study. / Wani, Sachin; Williams, J. Lucas; Komanduri, Srinadh; Muthusamy, V. Raman; Shaheen, Nicholas J.

In: The American journal of gastroenterology, Vol. 114, No. 8, 01.08.2019, p. 1256-1264.

Research output: Contribution to journalArticle

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AB - INTRODUCTION: Guidelines recommend that patients with non-dysplastic Barrett's esophagus (NDBE) undergo surveillance endoscopy every 3-5 years. Using a national registry, we assessed compliance to recommended surveillance intervals in patients with NDBE and identified factors associated with compliance. METHODS: We analyzed data from the GI Quality Improvement Consortium registry. Data abstracted include procedure indication, demographics, endoscopy/pathology results, and recommendations for future endoscopy. Patients with an indication of Barrett's esophagus (BE) screening or surveillance, or an endoscopic finding of BE, with non-dysplastic intestinal metaplasia on pathological examination, were included. Compliance was defined as a recommendation to undergo subsequent endoscopy between 3 and 5 years. Multivariate logistic regression was conducted to assess variables associated with compliance. RESULTS: Of 786,712 endoscopies assessed, 58,709 (7.5%) endoscopies in 53,541 patients met inclusion criteria (mean age 61.3 years, 60.4% men, 90.2% white, mean BE length was 2.3 cm). Most cases were performed by Gastroenterologists (92.3%) with propofol (78.7%). A total of 29,978 procedures (55.8%) resulted in pathology-confirmed BE. Among procedures with NDBE (n = 25,945), 29.9% were noncompliant with the 3-year threshold; most (26.9%) recommended surveillance at 1- to 2-year intervals. Patient factors such as extremes of age, black race, geographic region, type of sedation, and increasing BE length were associated with noncompliance. DISCUSSION: Approximately 30% of patients with NDBE are recommended to undergo surveillance endoscopy too soon. Patient factors associated with inappropriate utilization include extremes of age, black race, and increasing BE length. Compliance with appropriate endoscopic follow-up as a quality measure in BE is poor.

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