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Ksahiwagi K, Yoshida T, Fukuhara K, Bessho R, Ichikawa H, Inoue N, Takaishi H, Iwao Y, Kanai T. Optimal number of images and 2-year interval affect cancer detection in screening esophagogastroduodenoscopy: An observational study. Medicine (Baltimore) 2024; 103:e38774. [PMID: 38941380 DOI: 10.1097/md.0000000000038774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/30/2024] Open
Abstract
We aimed to identify quality indicator for esophagogastroduodenoscopy for detecting upper gastrointestinal (UGI) cancer. Data from 43,526 consecutive health checkups from August 2012 to January 2022 were retrospectively collected. The study ultimately analyzed 42,387 examinations by 12 endoscopists who performed more than 1000 examinations, including all cancers detected. These endoscopists were classified either into fast/slow group based on their mean examination time for a normal finding of esophagogastroduodenoscopy during their first year of the examination, or small/large group based on number of endoscopic images, respectively. The association between UGI cancer detection rate and examination time or the number of images was analyzed, using 5 minutes or 50 images as cutoff values. The detection rate of overall (8 pharyngeal, 39 esophageal, 69 gastric) cancers in the fast, slow, small, and large groups were 0.17%, 0.32%, 0.21%, and 0.31%, respectively. On multivariable analysis, endoscopists in the fast group or the small group were less likely to detect overall UGI cancer (OR: 0.596, 95% CI: 0.373-0.952, P = .030; OR: 0.652, 95% CI: 0.434-0.979, P = .039). Additionally, repeated endoscopy within 2 years had a higher overall cancer detection rate, compared with repeated screening after 2 years. In a sub-analysis, a significant negative relationship was found between the detection rate of gastric cancer and the number of gastric images < 35 (OR: 0.305, 95% CI: 0.189-0.492, P = .000). There was also a negative correlation trend between the detection rate of pharyngeal and esophageal cancers and the number of esophageal images < 11 (OR: 0.395, 95% CI: 0.156-1.001, P = .050). The optimal number of images and screening 2-year interval are considered useful quality indicators for detecting UGI cancer. This study also suggests that a total of 50 images, or 35 images of the stomach are suitable for detecting UGI cancer, or gastric cancer, during screening endoscopy.
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Affiliation(s)
- Kazuhiro Ksahiwagi
- Center for Preventive Medicine, Keio University, Tokyo, Japan
- Hills Joint Research Laboratory for Future Preventive Medicine and Wellness, School of Medicine, Keio University, Tokyo, Japan
| | | | - Kayoko Fukuhara
- Center for Preventive Medicine, Keio University, Tokyo, Japan
| | - Rieko Bessho
- Center for Preventive Medicine, Keio University, Tokyo, Japan
| | | | - Nagamu Inoue
- Center for Preventive Medicine, Keio University, Tokyo, Japan
| | | | - Yasushi Iwao
- Center for Preventive Medicine, Keio University, Tokyo, Japan
| | - Takanori Kanai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan
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Elmunzer BJ, Anderson MA, Mishra G, Rex DK, Yadlapati R, Shaheen NJ. TEMPORARY REMOVAL: Quality indicators common to all GI endoscopic procedures. Gastrointest Endosc 2024:S0016-5107(24)03183-3. [PMID: 38935015 DOI: 10.1016/j.gie.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 05/01/2024] [Indexed: 06/28/2024]
Abstract
The publisher regrets that this article has been temporarily removed. A replacement will appear as soon as possible in which the reason for the removal of the article will be specified, or the article will be reinstated. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/policies/article-withdrawal.
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Affiliation(s)
- B Joseph Elmunzer
- Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Michelle A Anderson
- Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Girish Mishra
- Section on Gastroenterology and Hepatology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Douglas K Rex
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Rena Yadlapati
- Division of Gastroenterology & Digestive Health, University of California San Diego, San Diego, California, USA
| | - Nicholas J Shaheen
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Kamionkowski S, Shibli F, Saleh S, Trujillo S, Mengalle E, El Mokahal A, Thomas C, Song G, Fass R. Clinical value of random esophageal biopsies in patients with dysphagia and normal endoscopy who are treated with a proton pump inhibitor. Dis Esophagus 2024; 37:doad070. [PMID: 38197434 DOI: 10.1093/dote/doad070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 08/22/2023] [Accepted: 11/24/2023] [Indexed: 01/11/2024]
Abstract
Rome IV recommended esophageal biopsies in patients with dysphagia and normal endoscopy to exclude mucosal disease. Thus far, studies evaluating the utility of this recommendation remain scarce. The aims of this study were to determine the value of random esophageal biopsies in heartburn patients with dysphagia and normal endoscopy and compare the yield of random esophageal biopsies between younger versus older patients. Data were collected from consecutive patients presenting with dysphagia, 18 years and older, who were on proton pump inhibitors and had normal upper endoscopy. Biopsy results of patients with and without heartburn were recorded. Logistic regression analysis was used to compare normal versus abnormal biopsy results in younger and older patients accounting for confounding variables. The number of abnormal biopsies was significantly higher than normal biopsies (68% and 32%, respectively, P = 0.0001). Among abnormal biopsy results, microscopic gastroesophageal reflux disease was significantly more common than all other findings (39%, P = 0.0495). There was no significant difference in biopsy results in patients with and without heartburn as well as younger versus older patients (P = 0.3384, P = 0.1010, and P = 0.8468, respectively). Our study demonstrated that most patients with dysphagia and normal upper endoscopy who are on proton pump inhibitor have some type of histologic mucosal abnormality, which can direct future management. Among abnormal biopsies, microscopic reflux was by far the most common finding in patients with or without a history of heartburn. While this supports the management strategy proposed by Rome IV, age did not drive esophageal biopsy results.
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Affiliation(s)
- Sara Kamionkowski
- Department of Internal Medicine, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH, USA
| | - Fahmi Shibli
- Division of Gastroenterology and Hepatology, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH, USA
| | - Sherif Saleh
- Department of Internal Medicine, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH, USA
| | - Sophie Trujillo
- Department of Internal Medicine, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH, USA
| | - Erika Mengalle
- Department of Internal Medicine, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH, USA
| | - Ali El Mokahal
- Department of Internal Medicine, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH, USA
| | - Charles Thomas
- Department of Research and Scholarship, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH, USA
| | - Gengqing Song
- Division of Gastroenterology and Hepatology, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH, USA
| | - Ronnie Fass
- Division of Gastroenterology and Hepatology, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH, USA
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Xin L, Gao Y, Cheng Z, Wang T, Lin H, Pang Y, Sun C, Fu Z, Li Z, Ma X, Wang L. Utilization and quality assessment of digestive endoscopy in China: results from 5-year consecutive nationwide surveys. Chin Med J (Engl) 2022; 135:2003-2010. [PMID: 36070457 PMCID: PMC9746725 DOI: 10.1097/cm9.0000000000002366] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Worldwide, the volume and availability of digestive endoscopy have undergone dramatic development in recent years, with increasing attention on quality assurance. We investigated the utilization and quality of digestive endoscopy in China from 2015 to 2019 and developed a quantitative quality evaluation tool for medical institutions. METHODS We invited all tertiary/secondary hospitals in Chinese mainland to participate in the survey annually. The questionnaires included the personnel, annual volume, and quality indicators of endoscopy. An endoscopy quality index (EQI) was developed based on recorded quality indicators using principal component analysis to determine the relative weight. RESULTS From 2015 to 2019, 806, 1412, 2644, 2468, and 2541 hospitals were respectively enrolled in this study. The average annual volume of endoscopy increased from 12,445 to 16,206 (1.30-fold) and from 2938 to 4255 (1.45-fold) in tertiary and secondary hospitals, respectively. The most obvious growth was observed in diagnostic colonoscopy (1.44-fold for all hospitals after standardization). The proportion of early cancer among all esophageal and gastric cancers during diagnostic esophagogastroduodenoscopy increased from 12.3% (55,210/448,861) to 17.7% (85,429/482,647) and from 11.4% (69,411/608,866) to 16.9% (107,192/634,235), respectively. The adenoma detection rate of diagnostic colonoscopy increased from 14.9% (2,118,123/14,215,592) to 19.3% (3,943,203/20,431,104). The EQI model included 12 quality indicators, incorporating 64.9% (7.792/12) of the total variance into one comprehensive index. According to the EQI measurements, the quality of endoscopy was higher in tertiary hospitals and hospitals in developed areas with higher volume or more endoscopists than that in other hospitals. CONCLUSIONS Digestive endoscopy in China has developed considerably in recent years in terms of both volume and quality. The EQI is a promising tool to quantify the quality of endoscopy at different hospitals.
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Affiliation(s)
- Lei Xin
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, Naval Medical University, Shanghai 200433, China
| | - Ye Gao
- Graduate School, Naval Medical University, Shanghai 200433, China
| | - Zhiyuan Cheng
- Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200240, China
| | - Tianjiao Wang
- National Digestive Endoscopy Improvement System, Changhai Hospital, Naval Medical University, Shanghai 200433, China
| | - Han Lin
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, Naval Medical University, Shanghai 200433, China
| | - Yanan Pang
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, Naval Medical University, Shanghai 200433, China
| | - Chang Sun
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, Naval Medical University, Shanghai 200433, China
| | - Zengjun Fu
- National Digestive Endoscopy Improvement System, Changhai Hospital, Naval Medical University, Shanghai 200433, China
| | - Zhaoshen Li
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, Naval Medical University, Shanghai 200433, China
- National Digestive Endoscopy Improvement System, Changhai Hospital, Naval Medical University, Shanghai 200433, China
| | - Xudong Ma
- Department of Medical Quality, Medical and Health Administration, National Health Commission of China, Beijing 100044, China
| | - Luowei Wang
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, Naval Medical University, Shanghai 200433, China
- National Digestive Endoscopy Improvement System, Changhai Hospital, Naval Medical University, Shanghai 200433, China
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Weissman S, Aziz M, Baniqued MR, Taneja V, El-Dallal M, Lee-Smith W, Elias S, Feuerstein JD. Quality measures in endoscopy: A systematic analysis of the overall scientific level of evidence and conflicts of interest. Endosc Int Open 2022; 10:E776-E786. [PMID: 35692919 PMCID: PMC9187391 DOI: 10.1055/a-1809-4219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 03/15/2022] [Indexed: 11/30/2022] Open
Abstract
Background and study aims Quality measures were established to develop standards to help assess quality of care, yet variation in endoscopy exists. We performed a systematic review to assess the overall quality of evidence cited in formulating quality measures in endoscopy. Methods A systematic search was performed on multiple databases from inception until November 15, 2020, to examine the quality measures proposed by all major societies. Quality measures were assessed for their level of quality evidence and categorized as category A (guideline-based), category B (observational studies) or category C (expert opinion). They were also examined for the type of measure (process, structure, outcome), the quality, measurability, review, existing conflicts of interest (COI), and patient participation of the quality measure. Results An aggregate total of 214 quality measures from nine societies (15 manuscripts) were included and analyzed. Of quality measures in endoscopy, 71.5 %, 23.8 %, and 4.7 % were based on low, moderate, and high quality of evidence, respectively. The proportion of high-quality evidence across societies was significantly different ( P = 0.028). Of quality measures, 76 % were quantifiable, 18 % contained patient-centric outcomes, and 7 % reported outcome measures. None of the organizations reported on patient involvement or external review, six disclosed existing COI, and 40 % were published more than 5 years ago. Conclusions Quality measures are important to standardize clinical practice. Because over 70 % of quality measures in endoscopy are based on low-quality evidence, further studies are needed to improve the overall quality to effectively set a standard, reduce variation, and improve care in endoscopic practice.
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Affiliation(s)
- Simcha Weissman
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, New Jersey, United States
| | - Muhammad Aziz
- Division of Gastroenterology and Hepatology, University of Toledo Medical Center, Toledo, Ohio, United States
| | - Matthew R. Baniqued
- Hackensack Meridian Health School of Medicine, Hackensack, New Jersey, United States
| | - Vikas Taneja
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
| | - Mohammed El-Dallal
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
| | - Wade Lee-Smith
- Division of Gastroenterology and Hepatology, University of Toledo Medical Center, Toledo, Ohio, United States
| | - Sameh Elias
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, New Jersey, United States
| | - Joseph D. Feuerstein
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
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6
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Nielsen AB, Pedersen FM, Laursen CB, Konge L, Laursen S. Assessment of esophagogastroduodenoscopy skills on simulators before real-life performance. Endosc Int Open 2022; 10:E815-E823. [PMID: 35692913 PMCID: PMC9187394 DOI: 10.1055/a-1814-9747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 03/30/2022] [Indexed: 12/02/2022] Open
Abstract
Background and study aims Operator competency is essential for esophagogastroduodenoscopy (EGD) quality, which makes appropriate training with a final test important. The aims of this study were to develop a test for assessing skills in performing EGD, gather validity evidence for the test, and establish a credible pass/fail score. Methods An expert panel developed a practical test using the Simbionix GI Mentor II simulator (3 D Systems) and an EGD phantom (OGI 4, CLA Medical) with a diagnostic (DP) and a technical skills part (TSP) for a prospective validation study. During the test a supervisor measured: 1) total time; 2) degree of mucosal visualization; and 3) landmarks and pathology identification. The contrasting groups standard setting method was used to establish a pass/fail score. Results We included 15 novices (N), 10 intermediates (I), and 10 experienced endoscopists (E). The internal structure was high with a Cronbach's alpha of 0.76 for TSP time consumption and 0.74 for the identification of landmarks. Mean total times, in minutes, for the DP were N 15.7, I 11.3, and E 7.0, and for TSP., they were N 7.9, I 8.9, and E 2.9. The total numbers of identified landmarks were N 26, I 41, and E 48. Mean visualization percentages were N 80, I 71, and E 71. A pass/fail standard was established requiring identification of all landmarks and performance of the TSP in < 5 minutes. All experienced endoscopists passed, while none of the endoscopists in the other categories did. Conclusions We established a test that can distinguish between participants with different competencies. This enables an objective and evidence-based approach to assessment of competencies in EGD.
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Affiliation(s)
- Anders Bo Nielsen
- Odense University Hospital, SimC – Simulation Center, Odense, Denmark,Odense University Hospital, Department of Medical Gastroenterology, Odense, Denmark,University of Southern Denmark, Department of Clinical Research, Odense, Denmark
| | - Finn Møller Pedersen
- Odense University Hospital, Department of Medical Gastroenterology, Odense, Denmark,University of Southern Denmark, Department of Clinical Research, Odense, Denmark
| | - Christian B. Laursen
- Odense University Hospital, Department of Respiratory Medicine, Odense, Denmark,University of Southern Denmark, Respiratory Research Unit, Odense, Denmark
| | - Lars Konge
- Capital Region of Denmark – Copenhagen Academy for Medical Education and Simulation, Copenhagen, Denmark
| | - Stig Laursen
- Odense University Hospital, Department of Medical Gastroenterology, Odense, Denmark,University of Southern Denmark, Department of Clinical Research, Odense, Denmark
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Turshudzhyan A, Rezaizadeh H, Tadros M. Lessons learned: Preventable misses and near-misses of endoscopic procedures. World J Gastrointest Endosc 2022; 14:302-310. [PMID: 35719899 PMCID: PMC9157695 DOI: 10.4253/wjge.v14.i5.302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/01/2021] [Accepted: 04/21/2022] [Indexed: 02/06/2023] Open
Abstract
Endoscopy is a complex procedure that requires advanced training and a highly skilled practitioner. The advances in the field of endoscopy have made it an invaluable diagnostic tool, but the procedure remains provider dependent. The quality of endoscopy may vary from provider to provider and, as a result, is not perfect. Consequently, 11.3% of upper gastrointestinal neoplasms are missed on the initial upper endoscopy and 2.1%-5.9% of colorectal polyps or cancers are missed on colonoscopy. Pathology is overlooked if endoscopic exam is not done carefully, bypassing proper visualization of the scope’s entry and exit points or, if exam is not taken to completion, not visualizing the most distal bowel segments. We hope to shed light on this issue, establish areas of weakness, and propose possible solutions and preventative measures.
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Affiliation(s)
- Alla Turshudzhyan
- Department of Medicine, University of Connecticut, Farmington, CT 06030, United States
| | - Houman Rezaizadeh
- Department of Gastroenterology and Hepatology, University of Connecticut, Farmington, CT 06030, United States
| | - Micheal Tadros
- Department of Gastroenterology and Hepatology, Albany Medical College, Albany, NY 12208, United States
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8
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Diagnosis and Management of Barrett's Esophagus: An Updated ACG Guideline. Am J Gastroenterol 2022; 117:559-587. [PMID: 35354777 DOI: 10.14309/ajg.0000000000001680] [Citation(s) in RCA: 142] [Impact Index Per Article: 71.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 02/04/2022] [Indexed: 02/07/2023]
Abstract
Barrett's esophagus (BE) is a common condition associated with chronic gastroesophageal reflux disease. BE is the only known precursor to esophageal adenocarcinoma, a highly lethal cancer with an increasing incidence over the last 5 decades. These revised guidelines implement Grading of Recommendations, Assessment, Development, and Evaluation methodology to propose recommendations for the definition and diagnosis of BE, screening for BE and esophageal adenocarcinoma, surveillance of patients with known BE, and the medical and endoscopic treatment of BE and its associated early neoplasia. Important changes since the previous iteration of this guideline include a broadening of acceptable screening modalities for BE to include nonendoscopic methods, liberalized intervals for surveillance of short-segment BE, and volume criteria for endoscopic therapy centers for BE. We recommend endoscopic eradication therapy for patients with BE and high-grade dysplasia and those with BE and low-grade dysplasia. We propose structured surveillance intervals for patients with dysplastic BE after successful ablation based on the baseline degree of dysplasia. We could not make recommendations regarding chemoprevention or use of biomarkers in routine practice due to insufficient data.
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9
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Kerdsirichairat T, Shin EJ. Important Quality Metrics and Standardization in Endoscopy. Gastrointest Endosc Clin N Am 2021; 31:727-742. [PMID: 34538412 DOI: 10.1016/j.giec.2021.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Quality metrics and standardization has become critical as the Affordable Care Act mandates that the Center for Medicare and Medicaid Services change reimbursement from volume to a value-based system. While the most commonly used quality indicators are related to that of colonoscopy, quality metrics for other procedures and endoscopy units have been developed mainly by the American College of Gastroenterology and the American Society of Gastrointestinal Endoscopy. Data to show that these quality metrics, especially in the field of advanced endoscopy as well as in the era of COVID-19 pandemic, can improve patient outcomes, are anticipated.
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Affiliation(s)
- Tossapol Kerdsirichairat
- Digestive Disease Center, Bumrungrad International Hospital, Bangkok, Thailand 33 Soi Sukhumvit 3, Wattana, Bangkok 10110 Thailand
| | - Eun Ji Shin
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins Medical Institutions, 1800 Orleans Street, Sheikh Zayed Tower, Suite 7125H, Baltimore, MD 21287, USA.
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10
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Public Preferences and Predicted Uptake for Esophageal Cancer Screening Strategies: A Labeled Discrete Choice Experiment. Clin Transl Gastroenterol 2021; 11:e00260. [PMID: 33105164 PMCID: PMC7587448 DOI: 10.14309/ctg.0000000000000260] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION: As novel, less invasive (non)endoscopic techniques for detection of Barrett's esophagus (BE) have been developed, there is now renewed interest in screening for BE and related neoplasia. We aimed to determine public preferences for esophageal adenocarcinoma screening to understand the potential of minimally invasive screening modalities. METHODS: A discrete choice experiment was conducted in 1,500 individuals, aged 50–75 years, from the general population. Individuals were repeatedly asked to choose between screening scenarios based on conventional upper endoscopy, transnasal endoscopy, nonendoscopic cell collection devices, breath analysis, and a blood test, combined with various levels of test sensitivity and specificity, and no screening. A multinomial logit model was used to estimate individuals' preferences and to calculate expected participation rates. RESULTS: In total, 554 respondents (36.9%) completed the survey. The average predicted uptake was 70.5% (95% confidence interval: 69.1%–71.8%). Test sensitivity (47.7%), screening technique (32.6%), and specificity (19.7%) affected screening participation (all P < 0.05). A low test sensitivity had the highest impact on screening participation, resulting in a 25.0% (95% confidence interval: 22.6%–27.7%) decrease. Respondents preferred noninvasive screening tests over endoscopic and capsule-based techniques, but only if sensitivity and specificity were above 80%. DISCUSSION: Our study suggests that individuals generally prefer noninvasive BE screening tests. However, these tests would unlikely improve screening uptake when associated with a much lower accuracy for detecting BE and esophageal adenocarcinoma compared with conventional upper endoscopy. Improving accuracy of minimally invasive screening strategies and informing the target population about these accuracies is therefore essential to maximally stimulate screening participation.
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11
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Forbes N, Chau M, Koury HF, Lethebe BC, Smith ZL, Wani S, Keswani RN, Elmunzer BJ, Anderson JT, Heitman SJ, Hilsden RJ. Development and validation of a patient-reported scale for tolerability of endoscopic procedures using conscious sedation. Gastrointest Endosc 2021; 94:103-110.e2. [PMID: 33385464 PMCID: PMC8761529 DOI: 10.1016/j.gie.2020.12.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 12/18/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Patient-reported experience measures (PREMs) assessing the tolerability of endoscopic procedures are scarce. In this study, we designed and validated a PREM to assess tolerability of endoscopy using conscious sedation. METHODS The patient-reported scale for tolerability of endoscopic procedures (PRO-STEP) consists of questions within 2 domains and is administered to outpatients at discharge from the endoscopy unit. Domain 1 (intraprocedural) consists of 2 questions regarding discomfort/pain and awareness, whereas domain 2 (postprocedural) consists of 4 questions on pain, nausea, distention, and either throat or anal pain. All questions are scored on a Likert scale from 0 to 10. Cronbach's alpha was used to measure internal consistency of the questions. Multivariable logistic regression was performed to assess predictors of higher scores, reported using adjusted odds ratios and confidence intervals. RESULTS Two hundred fifty-five patients (91 colonoscopy, 73 gastroscopy, and 91 ERCP) were included. Colonoscopy was the least tolerable procedure by recall, with mean intraprocedural awareness and discomfort scores of 5.1 ± 3.8, and 2.6 ± 2.7, respectively. Consistency between intraprocedural awareness and discomfort/pain yielded an acceptable Cronbach's alpha of .71 (95% confidence interval, .62-.78). Higher use of midazolam during colonoscopy was inversely associated with an intraprocedural awareness score of 7 or higher (per additional mg: adjusted odds ratio, .23; 95% confidence interval, .09-.54). CONCLUSIONS PRO-STEP is a simple PREM that can be administered after multiple endoscopic procedures using conscious sedation. Future work should focus on its performance characteristics in adverse event prediction.
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Affiliation(s)
- Nauzer Forbes
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Millie Chau
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
| | - Hannah F. Koury
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - B. Cord Lethebe
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Zachary L. Smith
- Department of Medicine, Division of Gastroenterology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Sachin Wani
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Denver, Colorado, USA
| | - Rajesh N. Keswani
- Division of Gastroenterology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - B. Joseph Elmunzer
- Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - John T. Anderson
- Department of Gastroenterology, Gloucestershire Hospitals NHSFT, Gloucester, UK
| | - Steven J. Heitman
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Robert J. Hilsden
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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12
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Jones B, Williams JL, Komanduri S, Muthusamy VR, Shaheen NJ, Wani S. Racial Disparities in Adherence to Quality Indicators in Barrett's Esophagus: An Analysis Using the GIQuIC National Benchmarking Registry. Am J Gastroenterol 2021; 116:1201-1210. [PMID: 33767105 DOI: 10.14309/ajg.0000000000001230] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 02/10/2021] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Racial disparities in outcomes in esophageal adenocarcinoma are well established. Using a nationwide registry, we aimed to compare clinical and endoscopic characteristics of blacks and whites with Barrett's esophagus (BE) and adherence to defined quality indicators. METHODS We analyzed data from the Gastrointestinal Quality Improvement Consortium Registry between January 2012 and December 2019. Patients who underwent esophagogastroduodenoscopy with an indication of BE screening or surveillance, or an endoscopic finding of BE, were included. Adherence to recommended endoscopic surveillance intervals of 3-5 years for nondysplastic BE and adherence to Seattle biopsy protocol were assessed. Multivariate logistic regression was conducted to assess variables associated with adherence. RESULTS A total of 100,848 esophagogastroduodenoscopies in 84,789 patients met inclusion criteria (blacks-3,957 and whites-96,891). Blacks were less likely to have histologically confirmed BE (34.3% vs 51.7%, P < 0.01), had shorter BE lengths (1.61 vs 2.35 cm, P < 0.01), and were less likely to have any dysplasia (4.3% vs 7.1%, P < 0.01). Although whites were predominantly male (62.2%), about half of blacks with BE were female (53.0%). Blacks with nondysplastic BE were less likely to be recommended appropriate surveillance intervals (OR 0.78; 95% CI 0.68-0.89). Adherence rates to the Seattle protocol were modestly higher among blacks overall (OR 1.12, 95% CI 1.04-1.20), although significantly lower among blacks with BE segments >6 cm. DISCUSSION The use of sex as a risk factor for BE screening may be inappropriate among blacks. Fewer blacks were recommended appropriate surveillance intervals, and blacks with longer segment BE were less likely to undergo Seattle biopsy protocol.
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Affiliation(s)
- Blake Jones
- University of Colorado School of Medicine, Division of Gastroenterology and Hepatology, Anschutz Medical Campus, Aurora, Colorado, USA
| | | | - Srinadh Komanduri
- Feinberg School of Medicine, Division of Gastroenterology and Hepatology, Northwestern University, Chicago, Illinois, USA
| | - V Raman Muthusamy
- Vatche and Tamar Manoukian Division of Digestive Diseases, University of California, Los Angeles, Los Angeles, California, USA
| | - Nicholas J Shaheen
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sachin Wani
- University of Colorado School of Medicine, Division of Gastroenterology and Hepatology, Anschutz Medical Campus, Aurora, Colorado, USA
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Implementation effect of institutional policy of EGD observation time on neoplasm detection. Gastrointest Endosc 2021; 93:1152-1159. [PMID: 32916166 DOI: 10.1016/j.gie.2020.09.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 09/02/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS The observation time in EGD is associated with detection rate of premalignant or neoplastic lesions in the upper GI (UGI) tract. The aim of this study was to evaluate an institutional policy of EGD observation time on the detection rate of UGI neoplasms. METHODS From July 2017 to March 2019, all endoscopists were requested to comply with our institutional policy of spending more than 3 minutes of observation time in every screening EGD. Observation time was defined as the time from when the endoscope reached the duodenum to when it was withdrawn. We obtained a neoplasm detection rate (NDR) during this period and compared it with that of a baseline period from 2009 to 2015. RESULTS During the study period, 30,506 EGDs were performed. Mean subject age was 49.9 ± 10.5 years, and 56.5% were men. All endoscopists achieved an average EGD observation time of more than 3 minutes during this period. Mean observation time was 3:35 ± 0:50, which was significantly longer than the baseline (2:38 ± 0:21, P < .001). NDR was .33%, which was higher than the baseline (.23%, P < .001). Even after adjusting for subjects' age and gender, smoking history, and endoscopists' biopsy sampling rate, prolonged EGD observation time of more than 3 minutes increased the NDR of UGI neoplasms (odds ratio, 1.51; 95% confidence interval, 1.21-1.75). CONCLUSIONS This study provides evidence that implementing a protocol of a prolonged observation time could increase NDR. Observation time should be an important quality indicator of the EGD examination.
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Abstract
Quality improvement is a dynamic process that requires continuously monitoring quality indicators and benchmarking these with national and professional standards. Endoscopists have formed societal task forces to propose quality indicators and performance goals. Institutions are now incentivized by payers and value-based reimbursement agreements to have processes in place to measure, report, and act on these quality metrics. Nationwide registries, such as the Gastrointestinal Quality Improvement Consortium, are used to report quality data to these merit-based incentive payment systems. Quality improvement processes such as these are instrumental to improve patient safety, health, and satisfaction while decreasing costs and medical errors.
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Affiliation(s)
- Chaitanya Vadlamudi
- Department of Surgery, MedStar Georgetown University Hospital, 3800 Reservoir Road NW, Gorman 2051, Washington DC 20007, USA
| | - Stacy Brethauer
- Department of Surgery, The Ohio State University, 410 West 10th Avenue, N721 Doan Hall, Columbus, OH 43210, USA.
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Wani S, Williams JL, Falk GW, Komanduri S, Muthusamy VR, Shaheen NJ. An Analysis of the GIQuIC Nationwide Quality Registry Reveals Unnecessary Surveillance Endoscopies in Patients With Normal and Irregular Z-Lines. Am J Gastroenterol 2020; 115:1869-1878. [PMID: 33156106 DOI: 10.14309/ajg.0000000000000960] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Population-based estimates of adherence to Barrett's esophagus (BE) guidelines are not available. Using a national registry, we assessed surveillance intervals for patients with normal and irregular Z-lines based on the presence or absence of intestinal metaplasia (IM) and among patients with suspected or confirmed BE. METHODS We analyzed data from the GI Quality Improvement Consortium Registry. Endoscopy data, including procedure indication, demographics, endoscopy and histology findings, and recommendations for further endoscopy, were assessed from January 2013 through December 2019. Patients with an indication of BE screening or surveillance or an endoscopic finding of BE were included. Biopsy and surveillance practices were assessed based on the length of columnar epithelium (0 cm, <1 cm, 1-3 cm, and >3 cm) and diagnosis based on histology findings. RESULTS A total of 1,907,801 endoscopies were assessed; 135,704 endoscopies (7.1%) performed in 114,894 patients met the inclusion criteria (men 61.4%, Whites 91%, and mean age of 61.7 years [SD 12.5]). Among patients with normal Z-lines, surveillance endoscopy was recommended for 81% of patients with IM and 20% of individuals without IM. Among patients with irregular Z-lines, surveillance endoscopy was recommended for 81% with IM and 24% without IM. Approximately 30% of patients with confirmed nondysplastic BE (lengths 1-3 and >3 cm) had recommended surveillance intervals of <3 years. DISCUSSION An analysis of data from a nationwide quality registry demonstrated that patients without BE are receiving recommendations for surveillance endoscopies and many patients with nondysplastic BE are reexamined too soon.
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Affiliation(s)
- Sachin Wani
- University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
| | | | - Gary W Falk
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Srinadh Komanduri
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | | | - Nicholas J Shaheen
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Frontiers of Robotic Gastroscopy: A Comprehensive Review of Robotic Gastroscopes and Technologies. Cancers (Basel) 2020; 12:cancers12102775. [PMID: 32998213 PMCID: PMC7600666 DOI: 10.3390/cancers12102775] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 09/22/2020] [Accepted: 09/25/2020] [Indexed: 02/06/2023] Open
Abstract
Simple Summary With the rapid advancements of medical technologies and patients’ higher expectations for precision diagnostic and surgical outcomes, gastroscopy has been increasingly adopted for the detection and treatment of pathologies in the upper digestive tract. Correspondingly, robotic gastroscopes with advanced functionalities, e.g., disposable, dextrous and not invasive solutions, have been developed in the last years. This article extensively reviews these novel devices and describes their functionalities and performance. In addition, the implementation of artificial intelligence technology into robotic gastroscopes, combined with remote telehealth endoscopy services, are discussed. The aim of this paper is to provide a clear and comprehensive view of contemporary robotic gastroscopes and ancillary technologies to support medical practitioners in their future clinical practice but also to inspire and drive new engineering developments. Abstract Upper gastrointestinal (UGI) tract pathology is common worldwide. With recent advancements in robotics, innovative diagnostic and treatment devices have been developed and several translational attempts made. This review paper aims to provide a highly pictorial critical review of robotic gastroscopes, so that clinicians and researchers can obtain a swift and comprehensive overview of key technologies and challenges. Therefore, the paper presents robotic gastroscopes, either commercial or at a progressed technology readiness level. Among them, we show tethered and wireless gastroscopes, as well as devices aimed for UGI surgery. The technological features of these instruments, as well as their clinical adoption and performance, are described and compared. Although the existing endoscopic devices have thus far provided substantial improvements in the effectiveness of diagnosis and treatment, there are certain aspects that represent unwavering predicaments of the current gastroenterology practice. A detailed list includes difficulties and risks, such as transmission of communicable diseases (e.g., COVID-19) due to the doctor–patient proximity, unchanged learning curves, variable detection rates, procedure-related adverse events, endoscopists’ and nurses’ burnouts, limited human and/or material resources, and patients’ preferences to choose non-invasive options that further interfere with the successful implementation and adoption of routine screening. The combination of robotics and artificial intelligence, as well as remote telehealth endoscopy services, are also discussed, as viable solutions to improve existing platforms for diagnosis and treatment are emerging.
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Alcaraz Serrat JA, Córdova H, Moreira L, Pocurull A, Ureña R, Delgado-Guillena PG, Garcés-Durán R, Sendino O, García-Rodríguez A, González-Suárez B, Araujo IK, Ginès À, Llach J, Fernández-Esparrach G. Evaluation of long-term adherence to oesophagogastroduodenoscopy quality indicators. GASTROENTEROLOGIA Y HEPATOLOGIA 2020; 43:589-597. [PMID: 32674879 DOI: 10.1016/j.gastrohep.2020.01.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 01/23/2020] [Accepted: 01/28/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION In a previous study we demonstrated that a simple training programme improved quality indicators of Oesophagogastroduodenoscopy (OGD) achieving the recommended benchmarks. However, the long-term effect of this intervention is unknown. The aim of this study was to assess the quality of OGDs performed 3 years after of having completed a training programme. MATERIAL AND METHODS A comparative study of 2 cohorts was designed as follows: Group A included OGDs performed in 2016 promptly after a training programme and Group B with OGDs performed from January to March 2019, this group was also divided into 2 subgroups: subgroup B1 of Endoscopists who had participated in the previous training programme and subgroup B2 of Endoscopists who had not. The intra-procedure quality indicators proposed by ASGE-ACG were used. RESULTS A total of 1236 OGDs were analysed, 600 from Group A and 636 from Group B (439 subgroup B1 and 197 subgroup B2). The number of complete examinations was lower in Group B (566 [94.3%] vs. 551 [86.6%]; p<0.001). A significant decrease was observed in nearly all quality indicators and they did not reach the recommended benchmarks: retroflexion in the stomach (96% vs. 81%; p<0.001); Seattle biopsy protocol (86% vs. 50%; p=0.03), description of the upper GI bleeding lesion (100% vs. 62%; p<0.01), sufficient intestinal biopsy specimens (at least 4) in suspected coeliac disease (92.5% vs. 18%; p<0.001), photo documentation of the lesion (94% vs. 90%; p<0.05). Regarding the overall assessment of the procedure (including correct performance and adequate photo documentation), a significant decrease was also observed (90.5% vs. 62%; p<0.001). There were no differences between subgroups B1 and B2. CONCLUSIONS The improvement observed in 2016 after a training programme did not prevail after 3 years. In order to keep the quality of OGDs above the recommended benchmarks, it is necessary to implement continuous training programmes.
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Affiliation(s)
- José Andrés Alcaraz Serrat
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalunya, España
| | - Henry Córdova
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalunya, España; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, España; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), España
| | - Leticia Moreira
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalunya, España; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, España; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), España
| | - Anna Pocurull
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalunya, España
| | - Romina Ureña
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalunya, España
| | | | - Rodrigo Garcés-Durán
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalunya, España
| | - Oriol Sendino
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalunya, España; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, España; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), España
| | - Ana García-Rodríguez
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalunya, España
| | - Begoña González-Suárez
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalunya, España; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, España; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), España
| | - Isis K Araujo
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalunya, España
| | - Àngels Ginès
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalunya, España; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, España; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), España
| | - Josep Llach
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalunya, España; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, España; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), España
| | - Gloria Fernández-Esparrach
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalunya, España; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, España; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), España.
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Januszewicz W, Kaminski MF. Quality indicators in diagnostic upper gastrointestinal endoscopy. Therap Adv Gastroenterol 2020; 13:1756284820916693. [PMID: 32477426 PMCID: PMC7232050 DOI: 10.1177/1756284820916693] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 03/06/2020] [Indexed: 02/04/2023] Open
Abstract
Upper gastrointestinal (UGI) endoscopy contributes a major clinical service with consistently growing demand around the world. Its utility corresponds to varying epidemiological issues throughout the globe, with cancer screening and surveillance being of the utmost priority. Despite high accuracy in neoplasia detection, UGI endoscopy remains a highly operator-dependent procedure, characterized by a substantial rate of missed pathology. Despite an overall lack of high-quality performance measures, there is an increased level of awareness about the need for quality control of this procedure, which is reflected in several guidelines and position statements published in recent years. It is widely recognized that quality assessment should go beyond mere technical aspects of the examination, and include both pre- and post-procedural factors. By this means, quality control encompasses the entire patient experience with the health care provider, from appropriate indication and physical assessment, through high-quality endoscopy service, to appropriate follow up and patient satisfaction. This article aims to review the available and emerging quality metrics for UGI endoscopy, taken mostly from Western endoscopy societies, with references to Asian recommendations where appropriate. The paper is limited solely to diagnostic UGI endoscopy and does not include performance measures for therapeutic procedures.
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Affiliation(s)
| | - Michal F. Kaminski
- Department of Gastroenterological Oncology, the
Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology,
Warsaw, Poland,Department of Gastroenterology, Hepatology and
Clinical Oncology, Center of Postgraduate Medical Education, Warsaw,
Poland,Department of Cancer Prevention, the Maria
Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw,
Poland,Institute of Health and Society, University of
Oslo, Oslo, Norway
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19
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He Q, Bano S, Ahmad OF, Yang B, Chen X, Valdastri P, Lovat LB, Stoyanov D, Zuo S. Deep learning-based anatomical site classification for upper gastrointestinal endoscopy. Int J Comput Assist Radiol Surg 2020; 15:1085-1094. [PMID: 32377939 PMCID: PMC7316667 DOI: 10.1007/s11548-020-02148-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 03/31/2020] [Indexed: 02/07/2023]
Abstract
Purpose Upper gastrointestinal (GI) endoscopic image documentation has provided an efficient, low-cost solution to address quality control for endoscopic reporting. The problem is, however, challenging for computer-assisted techniques, because different sites have similar appearances. Additionally, across different patients, site appearance variation may be large and inconsistent. Therefore, according to the British and modified Japanese guidelines, we propose a set of oesophagogastroduodenoscopy (EGD) images to be routinely captured and evaluate its efficiency for deep learning-based classification methods. Methods A novel EGD image dataset standardising upper GI endoscopy to several steps is established following landmarks proposed in guidelines and annotated by an expert clinician. To demonstrate the discrimination of proposed landmarks that enable the generation of an automated endoscopic report, we train several deep learning-based classification models utilising the well-annotated images. Results We report results for a clinical dataset composed of 211 patients (comprising a total of 3704 EGD images) acquired during routine upper GI endoscopic examinations. We find close agreement between predicted labels using our method and the ground truth labelled by human experts. We observe the limitation of current static image classification scheme for EGD image classification. Conclusion Our study presents a framework for developing automated EGD reports using deep learning. We demonstrate that our method is feasible to address EGD image classification and can lead towards improved performance and additionally qualitatively demonstrate its performance on our dataset.
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Affiliation(s)
- Qi He
- Key Laboratory of Mechanism Theory and Equipment Design of Ministry of Education, Tianjin University, Tianjin, China
| | - Sophia Bano
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, UK
| | - Omer F Ahmad
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, UK
| | - Bo Yang
- General Hospital, Tianjin Medical University, Tianjin, China
| | - Xin Chen
- General Hospital, Tianjin Medical University, Tianjin, China
| | - Pietro Valdastri
- School of Electronic and Electrical Engineering, University of Leeds, Leeds, UK
| | - Laurence B Lovat
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, UK
| | - Danail Stoyanov
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, UK
| | - Siyang Zuo
- Key Laboratory of Mechanism Theory and Equipment Design of Ministry of Education, Tianjin University, Tianjin, China.
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20
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Min JK, Cha JM, Kwak MS, Yoon JY, Jung Y, Shin JE, Yang HJ. Quality Indicators and Outcome Measures of Endoscopy in the National Cancer Screening Program. Yonsei Med J 2019; 60:1054-1060. [PMID: 31637887 PMCID: PMC6813148 DOI: 10.3349/ymj.2019.60.11.1054] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 08/09/2019] [Accepted: 08/19/2019] [Indexed: 12/28/2022] Open
Abstract
PURPOSE Quality indicators of the National Endoscopy Quality Improvement Program (NEQIP) and outcome measures of endoscopy in the National Cancer Screening Program (NCSP) in Korea are not clear. We evaluated the quality indicators of the revised NEQIP and outcome measures of endoscopy at different types of healthcare facilities participating in the NCSP. MATERIALS AND METHODS This study was conducted between March and August 2018 in primary, secondary, and tertiary healthcare facilities that perform endoscopy as a part of the NCSP. Representative endoscopists completed a questionnaire for quality indicators of the NEQIP and provided data on outcome measures for endoscopy. RESULTS Quality indicators of the NEQIP were mostly acceptable. However, the quality indicators for annual volume of esophagogastroduodenoscopy (EGD) and colonoscopy, training for endoscopy quality improvement by endoscopy nursing staff, colonoscopy reports, documentation of pathologic lesions, quality of endoscopy reprocessing areas, and completion of endoscopy reprocessing education programs were suboptimal. For outcome measures of EGD, the number of photo-documentations and total procedure time were higher at tertiary healthcare facilities than at other facilities (p<0.001 and p=0.023, respectively). For the outcome measures of colonoscopy, colonoscopy completion rate and waiting times for colonoscopy were significantly higher at tertiary healthcare facilities than at other facilities (both p<0.001). CONCLUSION Outcome measures of endoscopy should be included as quality indicators of NCSP. However, universal outcome measures for all types of healthcare facilities should be established because performance levels of some outcome measures differ among individual healthcare facility types.
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Affiliation(s)
- Jun Ki Min
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Jae Myung Cha
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea
- Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea.
| | - Min Seob Kwak
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea
- Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jin Young Yoon
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea
- Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Yunho Jung
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Jeong Eun Shin
- Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Hyo Joon Yang
- Department of Internal Medicine and Gastrointestinal Cancer Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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Lee TH, Yoon JY, Paik CN, Choi HS, Jang JY. Updates on the Facilities, Procedures, and Performance of the Accredited Endoscopy Unit. Clin Endosc 2019; 52:431-442. [PMID: 31591280 PMCID: PMC6785413 DOI: 10.5946/ce.2019.164] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 09/05/2019] [Indexed: 12/28/2022] Open
Abstract
Endoscopic quality indicators can be classified into three categories, namely facilities and equipment, endoscopic procedures, and outcome measures. In 2019, the Korean Society of Gastrointestinal Endoscopy updated the accreditation of qualified endoscopy unit assessment items for these quality indicators to establish competence and define areas of continuous quality improvement. Here, we presented the updated program guidelines on the facilities, procedures, and performance of the accredited endoscopy unit. Many of these items have not yet been validated. However, the updated program will help in establishing competence and defining areas of continuous quality improvement in Korean endoscopic practice.
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Affiliation(s)
- Tae Hee Lee
- Institute for Digestive Research, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Jin Young Yoon
- Department of Internal Medicine, Kyung Hee University College of Medicine, Seoul, Korea
| | - Chang Nyol Paik
- Department of Internal Medicine, The Catholic University of Korea, St. Vincent's Hospital, Suwon, Korea
| | - Hyuk Soon Choi
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Jae-Young Jang
- Institute for Digestive Research, Soonchunhyang University Seoul Hospital, Seoul, Korea
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23
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Over-Utilization of Repeat Upper Endoscopy in Patients with Non-dysplastic Barrett's Esophagus: A Quality Registry Study. Am J Gastroenterol 2019; 114:1256-1264. [PMID: 30865017 DOI: 10.14309/ajg.0000000000000184] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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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Soroush A, Poneros JM, Lightdale CJ, Abrams JA. Shorter time to achieve endoscopic eradication is not associated with improved long-term outcomes in Barrett's esophagus. Dis Esophagus 2019; 32:5475051. [PMID: 30997483 DOI: 10.1093/dote/doz026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Quality indicators have been proposed for endoscopic eradication therapy of Barrett's esophagus (BE). One such measure suggests that complete eradication of intestinal metaplasia (CE-IM) should be achieved within 18 months of starting treatment. The aim of this study was to assess whether achievement of CE-IM within 18 months is associated with improved long-term clinical outcomes. This was a retrospective cohort study of BE patients who underwent endoscopic eradication. Time to CE-IM was recorded and categorized as ≤ or > 18 months. The main outcome measures were recurrence of IM and of dysplasia after CE-IM, defined as a single endoscopy without endoscopic evidence of BE or histologic evidence of intestinal metaplasia. Recurrence was analyzed using the Kaplan-Meier method and multivariable Cox proportional hazards modeling. A total of 290 patients were included in the analyses. The baseline histology was high-grade dysplasia or intramucosal carcinoma in 74.2% of patients. CE-IM was achieved in 85.5% of patients, and 54.1% of the cohort achieved CE-IM within 18 months. Achieving CE-IM within 18 months was not associated with reduced risk of recurrence of IM or dysplasia in both unadjusted and adjusted analyses. In this cohort, older age and increased BE length were associated with IM recurrence, and increased hiatal hernia size was associated with dysplasia recurrence. Compared to longer times, achieving CE-IM within 18 months was not associated with a reduced risk of recurrence of IM or dysplasia. Alternative evidence-based quality metrics for endoscopic eradication therapy should be identified.
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Affiliation(s)
- Ali Soroush
- Department of Medicine, Columbia University Medical Center, New York, USA
| | - John M Poneros
- Department of Medicine, Columbia University Medical Center, New York, USA
| | | | - Julian A Abrams
- Department of Medicine, Columbia University Medical Center, New York, USA
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25
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Januszewicz W, Wieszczy P, Bialek A, Karpinska K, Szlak J, Szymonik J, Rupinski M, Mroz A, Regula J, Kaminski MF. Endoscopist biopsy rate as a quality indicator for outpatient gastroscopy: a multicenter cohort study with validation. Gastrointest Endosc 2019; 89:1141-1149. [PMID: 30659831 DOI: 10.1016/j.gie.2019.01.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 01/02/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS The diagnosis of gastric premalignant conditions (GPCs) relies on endoscopy with mucosal sampling. We hypothesized that the endoscopist biopsy rate (EBR) might constitute a quality indicator for EGD, and we have analyzed its association with GPC detection and the rate of missed gastric cancers (GCs). METHODS We analyzed EGD databases from 2 high-volume outpatient units. EBR values, defined as the proportion of EGDs with ≥1 biopsy to all examinations were calculated for each endoscopist in Unit A (derivation cohort) and divided by the quartile values into 4 groups. Detection of GPC was calculated for each group and compared using multivariate clustered logistic regression models. Unit B database was used for validation. All patients were followed in the Cancer Registry for missed GCs diagnosed between 1 month and 3 years after EGDs with negative results. RESULTS Sixteen endoscopists in Unit A performed 17,490 EGDs of which 15,340 (87.7%) were analyzed. EBR quartile values were 22.4% to 36.7% (low EBR), 36.8% to 43.7% (moderate), 43.8% to 51.6% (high), and 51.7% and 65.8% (very-high); median value 43.8%. The odds ratios for the moderate, high, and very-high EBR groups of detecting GPC were 1.6 (95% confidence interval [CI], 1.3-1.9), 2.0 (95% CI, 1.7-2.4), and 2.5 (95% CI, 2.1-2.9), respectively, compared with the low EBR group (P < .001). This association was confirmed with the same thresholds in the validation cohort. Endoscopists with higher EBR (≥43.8%) had a lower risk of missed cancer compared with those in the lower EBR group (odds ratio, 0.44; 95% CI, 0.20-1.00; P = .049). CONCLUSIONS The EBR parameter is highly variable among endoscopists and is associated with efficacy in GPC detection and the rate of missed GCs.
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Affiliation(s)
- Wladyslaw Januszewicz
- Department of Gastroenterological Oncology, The Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland; Department of Gastroenterology, Hepatology and Clinical Oncology, Medical Centre for Postgraduate Education, Warsaw, Poland; MRC Cancer Unit, University of Cambridge, Cambridge, United Kingdom
| | - Paulina Wieszczy
- Department of Gastroenterology, Hepatology and Clinical Oncology, Medical Centre for Postgraduate Education, Warsaw, Poland; Department of Cancer Prevention, The Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - Andrzej Bialek
- Department of Gastroenterology, Pomeranian Medical University, Szczecin, Poland
| | - Katarzyna Karpinska
- Department of Pathomorphology, Pomeranian Medical University, Szczecin, Poland
| | - Jakub Szlak
- Department of Gastroenterological Oncology, The Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland
| | - Jakub Szymonik
- Department of Gastroenterological Oncology, The Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland
| | - Maciej Rupinski
- Department of Gastroenterological Oncology, The Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland; Department of Gastroenterology, Hepatology and Clinical Oncology, Medical Centre for Postgraduate Education, Warsaw, Poland
| | - Andrzej Mroz
- Department of Pathomorphology, Medical Centre for Postgraduate Education, Warsaw, Poland; Department of Pathology and Laboratory Medicine, The Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland
| | - Jaroslaw Regula
- Department of Gastroenterological Oncology, The Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland; Department of Gastroenterology, Hepatology and Clinical Oncology, Medical Centre for Postgraduate Education, Warsaw, Poland
| | - Michal F Kaminski
- Department of Gastroenterological Oncology, The Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland; Department of Gastroenterology, Hepatology and Clinical Oncology, Medical Centre for Postgraduate Education, Warsaw, Poland; Department of Cancer Prevention, The Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland; Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
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26
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Min JK, Cha JM, Cho YK, Kim JH, Yoon SM, Im JP, Jung Y, Moon JS, Kim JO, Jeen YT. Revision of Quality Indicators for the Endoscopy Quality Improvement Program of the National Cancer Screening Program in Korea. Clin Endosc 2018; 51:239-252. [PMID: 29874905 PMCID: PMC5997069 DOI: 10.5946/ce.2018.075] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 05/14/2018] [Indexed: 12/12/2022] Open
Abstract
Gastroscopy and colonoscopy are widely used for the early diagnosis of stomach and colorectal cancer. The present revision integrates recent data regarding previous quality indicators and novel indicators suggested for gastroscopy and colonoscopy procedures for the National Cancer Screening Program in Korea. The new indicators, developed by the Quality Improvement Committee of the Korean Society for Gastrointestinal Endoscopy, vary in the level of supporting evidence, and most are based solely on expert opinion. Updated indicators validated by clinical research were prioritized, but were chosen by expert consensus when such studies were absent. The resultant quality indicators were graded according to the levels of consensus and recommendations. The updated indicators will provide a relevant guideline for high-quality endoscopy. The future direction of quality indicator development should include relevant outcome measures and an evidence-based approach to support proposed performance targets.
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Affiliation(s)
- Jun Ki Min
- Department of Internal Medicine, Kyung Hee University Hospital at Gang Dong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jae Myung Cha
- Department of Internal Medicine, Kyung Hee University Hospital at Gang Dong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Yu Kyung Cho
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Jie-Hyun Kim
- Department of Internal Medicine, Yonsei University School of Medicine, Seoul, Korea
| | - Soon Man Yoon
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Jong Pil Im
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Yunho Jung
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Jeong Seop Moon
- Department of Internal Medicine, Inje University College of Medicine, Seoul, Korea
| | - Jin-Oh Kim
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Yoon Tae Jeen
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
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Min JK, Cha JM, Cho YK, Kim JH, Yoon SM, Im JP, Jung Y, Moon JS, Kim JO, Jeen YT. [Revision of Quality Indicators for the Endoscopy Quality Improvement Program of the National Cancer Screening Program in Korea]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2018; 71:269-281. [PMID: 29791986 DOI: 10.4166/kjg.2018.71.5.269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Gastroscopy and colonoscopy are widely used for the early diagnosis of stomach and colorectal cancer. The present revision integrates recent data regarding previous quality indicators and novel indicators suggested for gastroscopy and colonoscopy procedures for the National Cancer Screening Program in Korea. The new indicators, developed by the Quality Improvement Committee of the Korean Society for Gastrointestinal Endoscopy, vary in the level of supporting evidence, and most are based solely on expert opinion. Updated indicators validated by clinical research were prioritized, but were chosen by expert consensus when such studies were absent. The resultant quality indicators were graded according to the levels of consensus and recommendations. The updated indicators will provide a relevant guideline for high-quality endoscopy. The future direction of quality indicator development should include relevant outcome measures and an evidence-based approach to support proposed performance targets.
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Affiliation(s)
- Jun Ki Min
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jae Myung Cha
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Yu Kyung Cho
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Jie Hyun Kim
- Department of Internal Medicine, Yonsei University School of Medicine, Seoul, Korea
| | - Soon Man Yoon
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Jong Pil Im
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Yunho Jung
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Jeong Seop Moon
- Department of Internal Medicine, Inje University College of Medicine, Seoul, Korea
| | - Jin Oh Kim
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Yoon Tae Jeen
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
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Lisboa-Gonçalves P, Libânio D, Marques-Antunes J, Dinis-Ribeiro M, Pimentel-Nunes P. Quality of Reporting in Upper Gastrointestinal Endoscopy: Effect of a Simple Audit Intervention. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2018; 26:24-32. [PMID: 30675501 DOI: 10.1159/000487145] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 01/22/2018] [Indexed: 12/16/2022]
Abstract
Background and Aim In contrast to colonoscopy, there are few studies regarding upper gastrointestinal (UGI) endoscopy reporting its quality and ways of improving it. Quality audits are recommended, but their influence on the abovementioned quality is not well studied. Our aim was to evaluate the quality of UGI endoscopy reports and assess the effect of a simple audit intervention on UGI endoscopy reporting quality. Methods This was a prospective study in a tertiary referral center, including the evaluation of 1,000 consecutive reports of UGI endoscopies before an audit intervention and 250 after. The reports were analyzed according to performance measures defined by three experienced gastroenterologists. Results Before the intervention, 51.8% of the incomplete endoscopies did not present any justification for its incompleteness and 88.1% of lesions were correctly described. Overall, 64.1% of the reports were considered as being of high quality. After the audit intervention, follow-up recommendation (53.4 vs. 80.8%, p = 0.001), correct lesion description (88.1 vs. 95.8%, p = 0.001), and correct segment description (92.2 vs. 96.4%, p = 0.020) improved significantly. The rate of unjustified incomplete endoscopies decreased significantly (51.8 vs. 28.9%, p = 0.010). The high-quality endoscopy rate improved 13.9% after the intervention (p < 0.001). Both specialists and residents improved with the audit intervention with a similar percentage of improvement in the high-quality endoscopy rate (13.9 vs. 13.4%). Conclusions A simple audit intervention is a good way to improve the quality of reporting of UGI endoscopy, independently of degree and experience. Some of the performance measure accomplishments may depend on the software used by the endoscopy centers and it should be a priority to optimize it.
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Affiliation(s)
- Pedro Lisboa-Gonçalves
- Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Diogo Libânio
- Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal.,Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal
| | - Joana Marques-Antunes
- Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Mário Dinis-Ribeiro
- Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal.,Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal
| | - Pedro Pimentel-Nunes
- Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal.,Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
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29
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Cho YK. Quality standards and performance measures: steps to high quality diagnostic endoscopy. Transl Gastroenterol Hepatol 2018; 3:7. [PMID: 29441372 DOI: 10.21037/tgh.2018.01.04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 12/26/2017] [Indexed: 12/15/2022] Open
Affiliation(s)
- Yu Kyung Cho
- Department of Internal Medicine, The Catholic University of Korea, The College of Medicine, Seoul, Korea
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30
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Baumgardner JM, Sewell JL, Day LW. Assessment of quality indicators among nurse practitioners performing upper endoscopy. Endosc Int Open 2017; 5:E818-E824. [PMID: 28879227 PMCID: PMC5585072 DOI: 10.1055/s-0043-115384] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 06/21/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Limited international data have shown that non-physicians can safely perform upper endoscopy, but no such study has been performed in the United States. Our aim was to assess the quality of outpatient upper endoscopies performed by nurse practitioners (NPs). PATIENTS AND METHODS Retrospective chart review of upper endoscopies performed by 3 NPs between 2010 and 2013 was performed. Comparisons among all NPs performing upper endoscopy and assessment of individual NP performance over time with respect to quality indicators were performed. RESULTS Three NPs performed 333 upper endoscopies (distribution of 166, 44, and 123, respectively). Of the cases, 98.2 %s were successfully completed to the second portion of the duodenum. In most cases, photo-documentation of required anatomical landmarks was performed: GE junction (84.2 %), GE junction in retroflexed view (84.2 %), antrum (82.1 %) and duodenum (80.9 %). Photo-documentation improved with increasing experience. NPs appropriately performed biopsies for specific medical conditions: 10/11 (90.9 %) gastric ulcers were biopsied and 63/66 (95.5) of patients with iron deficiency had duodenal biopsies performed for celiac disease. A physician endoscopist was required during the procedure 22.5 % of the time. Important parameters such as documenting informed consent (100 %) and documenting a discharge plan (99.4 %) in the procedure reports were overwhelming present. There was a single adverse event during the study period. CONCLUSION In the first US study of NPs performing upper endoscopy, they were able to perform high-quality and safe upper endoscopies. These findings support incorporation of non-physicians alongside physicians to help meet the growing demand for endoscopic services across the United States.
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Affiliation(s)
- Jeffrey M. Baumgardner
- Division of Gastroenterology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California, United States,Corresponding author Jeffrey M. Baumgardner Zuckerberg San Francisco General Hospital and Trauma Center1001 Potrero AveSan Francisco CA 941101-415-206-5199
| | - Justin L. Sewell
- Division of Gastroenterology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California, United States
| | - Lukejohn W. Day
- Division of Gastroenterology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California, United States
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31
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Gawron AJ, Cole G, Hu N, Thompson WK, Fang J, Samore M. Regional Variability of Repeat Esophagogastroduodenoscopy Use in the National Veteran Population. Dig Dis Sci 2017; 62:2303-2310. [PMID: 28752419 DOI: 10.1007/s10620-017-4678-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 07/10/2017] [Indexed: 01/11/2023]
Abstract
BACKGROUND Esophagogastroduodenoscopy (EGD) procedures are performed frequently to evaluate gastrointestinal disease and symptoms. AIM To determine regional practice variability of repeat EGDs in a national population. METHODS The study sample included US Veterans with an outpatient index EGD from 1/1/2008 to 12/2010. We determined risk of repeat endoscopy from 1/2008 to 10/1/2014. A logistic regression model was used to assess the association between the odds of repeated EGD and patient demographics, ICD diagnostic codes, and geographic region. Multivariable logistic regression was performed to obtain the adjusted odds ratio and predicted probabilities of repeat EGDs by region. RESULTS A total of 202,086 patients had an index endoscopy from 1/2008 to 12/2010. Unique patients with an index endoscopy were predominantly male (93.2%), white (72.8%), and on average 61 years. A total of 58,469 patients (28.9%) had one or more repeat EGDs, accounting for 103,253 repeat procedures through 10/2014. ICD-9-CM codes associated with increased risk of repeat procedures were Barrett's esophagus (OR 3.6, 95% CI 3.5-3.7), dysphagia (OR 1.3, 95% CI 1.2-1.3), ulcer (OR 1.3, 95% CI 2.2-2.4), stricture (OR 1.8, 95% CI 1.7-1.9), and esophageal varices (OR 2.8, 95% CI 2.7-3.0). There was a significant difference in the probability of repeat EGD by VA region, with the Midwest region having the highest probability (31.2%) and Southeast the lowest probability (27.3%). This difference would account for 400 more EGD procedures per 10,000 Veterans, after adjusting for patient demographics and diagnosis codes. CONCLUSIONS Regional practice variability accounts for a substantial volume of repeat EGD procedures, regardless of patient characteristics and associated diagnoses.
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Affiliation(s)
- Andrew J Gawron
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Utah School of Medicine, 30 N 1900 E, SOM 4R118, Salt Lake City, UT, 84132, USA. .,Salt Lake City Specialty Care Center of Innovation, VA Salt Lake City Healthcare System, Salt Lake City, UT, USA. .,Salt Lake City (SLC) VA Informatics Decision Enhancement and Analytic Sciences Center, Salt Lake City, UT, USA.
| | - Garrett Cole
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Utah School of Medicine, 30 N 1900 E, SOM 4R118, Salt Lake City, UT, 84132, USA.,Salt Lake City Specialty Care Center of Innovation, VA Salt Lake City Healthcare System, Salt Lake City, UT, USA
| | - Nan Hu
- Huntsman Cancer Center, Salt Lake City, UT, USA
| | | | - John Fang
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Utah School of Medicine, 30 N 1900 E, SOM 4R118, Salt Lake City, UT, 84132, USA
| | - Matthew Samore
- Salt Lake City (SLC) VA Informatics Decision Enhancement and Analytic Sciences Center, Salt Lake City, UT, USA.,Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA
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Park JM, Huo SM, Lee HH, Lee BI, Song HJ, Choi MG. Longer Observation Time Increases Proportion of Neoplasms Detected by Esophagogastroduodenoscopy. Gastroenterology 2017; 153:460-469.e1. [PMID: 28501581 DOI: 10.1053/j.gastro.2017.05.009] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 05/02/2017] [Accepted: 05/04/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND & AIMS Esophagogastroduodenoscopy (EGD) is commonly used to detect upper gastrointestinal (GI) neoplasms. However, there is little evidence that longer examination time increases rate of detection of upper GI neoplasia. We investigated the association between length of time spent performing a normal screening EGD and rate of neoplasm detection. METHODS We performed a retrospective analysis of data from 111,962 subjects who underwent EGD as part of a comprehensive health-screening program from January 2009 to December 2015 in Korea. Endoscopy findings were extracted from reports prepared by 14 board-certified endoscopists. Endoscopists were classified as fast or slow based on their mean examination time for a normal EGD without biopsy during their first year of the study. All endoscopists used the same endoscopy unit. We obtained findings from histologic analyses of GI biopsies from patient records; positive findings were defined as the detection of neoplasms (esophageal, gastric, or duodenal lesions). We examined the association between examination time and proportions of neoplasms detected. The primary outcome measure was the rate of neoplasm detection for each endoscopist (total number of neoplastic lesions detected divided by the number of subjects screened) and as the proportion of subjects with at least 1 neoplastic lesion. RESULTS The mean examination time was 2 minutes 53 seconds. Using 3 minutes as a cutoff, we classified 8 endoscopists as fast (mean duration, 2:38 ± 0:21 minutes) and 6 endoscopists as slow (mean duration, 3:25 ± 0:19 minutes). Each endoscopist's mean examination time correlated with their rate of neoplasm detection (R2 = 0.54; P = .046). Fast endoscopists identified neoplasms in the upper GI tract in 0.20% of patients, whereas slow endoscopists identified these in 0.28% of patients (P = .0054). The frequency of endoscopic biopsy varied among endoscopists (range, 6.9%-27.8%) and correlated with rate of neoplasm detection (R2 = 0.76; P = .0015). On multivariable analysis, slow endoscopists were more likely to detect gastric adenomas or carcinomas than fast endoscopists (odds ratio, 1.52; 95% CI, 1.17-1.97). CONCLUSIONS In a retrospective analysis of data from more than 100,000 subjects who underwent EGD in a screening program, we found slow endoscopists detected a higher proportion of neoplasms than fast endoscopists. Examination time is therefore a useful indicator of quality for EGD.
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Affiliation(s)
- Jae Myung Park
- Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
| | - Sol Mi Huo
- Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Han Hee Lee
- Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Bo-In Lee
- Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Ho Jin Song
- Department of Health Promotion Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Myung-Gyu Choi
- Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
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Cha JM, Moon JS, Chung IK, Kim JO, Im JP, Cho YK, Kim HG, Lee SK, Lee HL, Jang JY, Kim ES, Jung Y, Moon CM, Kim Y, Park BY. National Endoscopy Quality Improvement Program Remains Suboptimal in Korea. Gut Liver 2017; 10:699-705. [PMID: 27282270 PMCID: PMC5003191 DOI: 10.5009/gnl15623] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Revised: 01/22/2016] [Accepted: 01/22/2016] [Indexed: 12/17/2022] Open
Abstract
Background/Aims We evaluated the characteristics of the National Cancer Screening Program (NCSP) and opinions regarding the National Endoscopy Quality Improvement Program (NEQIP). Methods We surveyed physicians performing esophagogastroduodenoscopy and/or colonoscopy screenings as part of the NCSP via e-mail between July and August in 2015. The 32-item survey instrument included endoscopic capacity, sedation, and reprocessing of endoscopes as well as opinions regarding the NEQIP. Results A total of 507 respondents were analyzed after the exclusion of 40 incomplete answers. Under the current capacity of the NCSP, the typical waiting time for screening endoscopy was less than 4 weeks in more than 90% of endoscopy units. Performance of endoscopy reprocessing was suboptimal, with 28% of respondents using unapproved disinfectants or not knowing the main ingredient of their disinfectants and 15% to 17% of respondents not following reprocessing protocols. Agreement with the NEQIP was optimal, because only 5.7% of respondents did not agree with NEQIP; however, familiarity with the NEQIP was suboptimal, because only 37.3% of respondents were familiar with the NEQIP criteria. Conclusions The NEQ-IP remains suboptimal in Korea. Given the suboptimal performance of endoscopy reprocessing and low familiarity with the NEQIP, improved quality in endoscopy reprocessing and better understanding of the NEQIP should be emphasized in Korea.
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Affiliation(s)
- Jae Myung Cha
- Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jeong Seop Moon
- Department of Internal Medicine, Inje University College of Medicine, Seoul, Korea
| | - Il-Kwun Chung
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Jin-Oh Kim
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Jong Pil Im
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Yu Kyung Cho
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Hyun Gun Kim
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Sang Kil Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hang Lak Lee
- Department of Internal Medicine, Hanyang University School of Medicine, Seoul, Korea
| | - Jae Young Jang
- Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Eun Sun Kim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Yunho Jung
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Chang Mo Moon
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Yeol Kim
- Cancer Early Detection Branch, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Bo Young Park
- Cancer Early Detection Branch, National Cancer Control Institute, National Cancer Center, Goyang, Korea
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Ward ST, Hancox A, Mohammed MA, Ismail T, Griffiths EA, Valori R, Dunckley P. The learning curve to achieve satisfactory completion rates in upper GI endoscopy: an analysis of a national training database. Gut 2017; 66:1022-1033. [PMID: 26976733 DOI: 10.1136/gutjnl-2015-310443] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 02/19/2016] [Accepted: 02/25/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The aim of this study was to determine the number of OGDs (oesophago-gastro-duodenoscopies) trainees need to perform to acquire competency in terms of successful unassisted completion to the second part of the duodenum 95% of the time. DESIGN OGD data were retrieved from the trainee e-portfolio developed by the Joint Advisory Group on GI Endoscopy (JAG) in the UK. All trainees were included unless they were known to have a baseline experience of >20 procedures or had submitted data for <20 procedures. The primary outcome measure was OGD completion, defined as passage of the endoscope to the second part of the duodenum without physical assistance. The number of OGDs required to achieve a 95% completion rate was calculated by the moving average method and learning curve cumulative summation (LC-Cusum) analysis. To determine which factors were independently associated with OGD completion, a mixed effects logistic regression model was constructed with OGD completion as the outcome variable. RESULTS Data were analysed for 1255 trainees over 288 centres, representing 243 555 OGDs. By moving average method, trainees attained a 95% completion rate at 187 procedures. By LC-Cusum analysis, after 200 procedures, >90% trainees had attained a 95% completion rate. Total number of OGDs performed, trainee age and experience in lower GI endoscopy were factors independently associated with OGD completion. CONCLUSIONS There are limited published data on the OGD learning curve. This is the largest study to date analysing the learning curve for competency acquisition. The JAG competency requirement for 200 procedures appears appropriate.
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Affiliation(s)
- S T Ward
- Centre for Liver Research & NIHR Birmingham Biomedical Research Unit, Level 5 Institute for Biomedical Research, University of Birmingham, Birmingham, UK
| | - A Hancox
- Department of Surgery, Birmingham Children's Hospital, Birmingham, UK
| | - M A Mohammed
- Faculty of Health Studies, University of Bradford, Bradford, UK.,Bradford Institute for Health Research, Bradford, Yorkshire, UK.,Humberside Academic Health Sciences Network, Wakefield, UK
| | - T Ismail
- Department of Colorectal Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - E A Griffiths
- Department of Upper Gastrointestinal Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - R Valori
- Department of Gastroenterology, Gloucestershire Royal Hospital, Gloucester, UK
| | - P Dunckley
- Department of Gastroenterology, Gloucestershire Royal Hospital, Gloucester, UK
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Yoo IK, Jeen YT. The Importance of an Endoscopic Quality Assessment Program Reflecting Real Practice. Clin Endosc 2016; 49:495-497. [PMID: 27842437 PMCID: PMC5152787 DOI: 10.5946/ce.2016.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 10/28/2016] [Accepted: 10/31/2016] [Indexed: 11/14/2022] Open
Affiliation(s)
- In Kyung Yoo
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Digestive Disease and Nutrition, Korea University College of Medicine, Seoul, Korea
| | - Yoon Tae Jeen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Digestive Disease and Nutrition, Korea University College of Medicine, Seoul, Korea
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Cho YK. How to Improve the Quality of Screening Endoscopy in Korea: National Endoscopy Quality Improvement Program. Clin Endosc 2016; 49:312-7. [PMID: 27484810 PMCID: PMC4977749 DOI: 10.5946/ce.2016.084] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 07/13/2016] [Accepted: 07/15/2016] [Indexed: 12/11/2022] Open
Abstract
In Korea, gastric cancer screening, either esophagogastroduodenoscopy or upper gastrointestinal series (UGIS), is performed biennially for adults aged 40 years or older. Screening endoscopy has been shown to be associated with localized cancer detection and better than UGIS. However, the diagnostic sensitivity of detecting cancer is not satisfactory. The National Endoscopy Quality Improvement (QI) program was initiated in 2009 to enhance the quality of medical institutions and improve the effectiveness of the National Cancer Screening Program (NCSP). The Korean Society of Gastrointestinal Endoscopy developed quality standards through a broad systematic review of other endoscopic quality guidelines and discussions with experts. The standards comprise five domains: qualifications of endoscopists, endoscopic unit facilities and equipment, endoscopic procedure, endoscopy outcomes, and endoscopic reprocessing. After 5 years of the QI program, feedback surveys showed that the perception of QI and endoscopic practice improved substantially in all domains of quality, but the quality standards need to be revised. How to avoid missing cancer in endoscopic procedures in daily practice was reviewed, which can be applied to the mass screening endoscopy. To improve the quality and effectiveness of NCSP, key performance indicators, acceptable quality standards, regular audit, and appropriate reimbursement are necessary.
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Affiliation(s)
- Yu Kyung Cho
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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