Endoscopists systematically undersample patients with long-segment Barrett's esophagus: an analysis of biopsy sampling practices from a quality improvement registry.
Guidelines recommend systematic biopsy sampling in Barrett's esophagus (BE) to reduce sampling error. Adherence to this biopsy sampling protocol has been suggested as a quality indicator; however, estimates of adherence are not available. Using a national registry, we assessed adherence and identifi...
| Publicado en: | Gastrointestinal Endoscopy Vol. 90; no. 5; pp. 732 - 733 |
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| Autores principales: | , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Elsevier B.V.
Nov2019
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=139191576&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 139191576 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00165107 4A9 jtl: Gastrointestinal Endoscopy issn: 00165107 maglogo: N pubinfo: dt: Nov2019 vid: 90 iid: 5 pid: 467 pub: Elsevier B.V. place: New York, New York artinfo: ui: 139191576 139191576 139191576 10.1016/j.gie.2019.04.250 139191576 ppf: 732 ppct: 1 formats: tig: atl: Endoscopists systematically undersample patients with long-segment Barrett's esophagus: an analysis of biopsy sampling practices from a quality improvement registry. aug: au: Wani, Sachin Williams, J. Lucas Komanduri, Srinadh Muthusamy, V. Raman Shaheen, Nicholas J. affil: Division of Gastroenterology and Hepatology, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA sug: subj: Endoscopy Health Personnel Barrett Esophagus Biopsy Utilization Guideline Adherence Sampling Error Human Record Review Practice Guidelines Clinical Indicators Health Screening Disease Surveillance Descriptive Statistics Odds Ratio Confidence Intervals Middle Age Age Factors Sex Factors Race Factors Professional Competence Research Subject Recruitment Middle Aged: 45-64 years ab: Guidelines recommend systematic biopsy sampling in Barrett's esophagus (BE) to reduce sampling error. Adherence to this biopsy sampling protocol has been suggested as a quality indicator; however, estimates of adherence are not available. Using a national registry, we assessed adherence and identified predictors of adherence to biopsy sampling protocols. We analyzed data from the GI Quality Improvement Consortium Registry that included procedure indication, demographics, endoscopy, and pathology results. Patients with an indication of BE screening/surveillance or an endoscopic finding of BE were included. Adherence to the Seattle protocol was assessed by dividing BE length by number of pathology jars, with a ratio ≤2.0 with rounding down (lenient definition) or rounding up (stringent definition) for odd BE lengths considered adherent. Variables associated with adherence were assessed using generalized estimating equations to control for clustering within individual physicians. Of 786,712 EGDs assessed, 58,709 (7.5%) EGDs in 53,541 patients met inclusion criteria (mean age, 61.3 years; 60.4% men; 90.2% white; mean BE length, 2.3 cm). When the lenient and stringent definitions for adherence were used, 87.8% and 82.7% of EGDs were adherent, respectively. Increasing BE length was the most significant predictor of nonadherence (odds ratio,.69; 95% confidence interval,.67-.71). Other predictors were increasing age, male gender, increasing American Society of Anesthesiologists class, and practice location. Performance of EGD by nongastroenterologist physicians was associated with nonadherence (odds ratio,.07; 95% confidence interval,.06-.10). Nearly 20% of endoscopies performed in BE patients were not adherent to the Seattle protocol. As BE length increases, endoscopists become less compliant with odds of nonadherence increasing by 31% with every 1-cm increase in length. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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