One of the most common procedures in gastroenterology – esophagogastroduodenoscopy (EGD) – needs to consistently meet quality measures, but data on interventions to improve them is lacking, according to a recent review.
Researchers, led by Fateh Bazerbachi, MD, with CentraCare, Interventional Endoscopy Program, at St. Cloud (Minn.) Hospital performed a systematic review of the literature to identify which interventions and measures have improved the performance of EGD quality indicators previously identified by the American Society for Gastrointestinal Endoscopy. They also looked for demonstrations of improving compliance with the prioritized indicators. The review appeared in Gastrointestinal Endoscopy.
The authors pointed out that more than 6.1 million EGDs are performed every year in the United States. Although gastroenterologists perform most of them, other providers also perform them, including primary care physicians, surgeons, and sometimes advanced practice providers. Therefore, establishing well-defined quality measures is critical for consistent outcomes.
Daniel C. Buckles, MD, associate professor of gastroenterology, hepatology & motility at the University of Kansas Medical Center in Kansas City, who was not part of the review, said high-quality EGDs are critical for many reasons, including avoiding overuse when results of the procedure are not likely to change a patient’s treatment but add risk to the patient and increase costs to the health care system.
“Lack of training to recognize important GI pathology seen on an EGD and lack of standardized reporting of GI abnormalities using validated classification systems can lead to suboptimal treatment and follow-up for patients,” he noted.
Testing provider adherence to guidelines years after publication helps providers understand what works and can improve outcomes, Buckles said.
Buckles said that one of the highlights of the review was that researchers were able to confidently say that use of standardized checklists and frequent auditing had value in improving preprocedural and postprocedural quality indicators.
“The authors also concluded that focused educational interventions might improve endoscopists’ abilities to adhere to standardized Barrett’s esophagus examinations,” he added. “Unfortunately, the authors were not able to find much evidence for interventions that would improve intraprocedural EGD quality indicators.”
The authors pointed to a prospective study that evaluated whether an audit intervention helped in 10,000 consecutive EGDs. They found the audits “improved EGD report quality, such as justification for incompleteness or accurate lesion/segment description, regardless of the endoscopist’s experience documenting the report (specialist vs. trainee).” When audits were used in other studies to evaluate endoscopy overall performance (including EGD and colonoscopy) results showed similar improvement in important endpoints, the authors wrote. Additionally, “use of dictation templates has been demonstrated to improve the completeness of endoscopy report.”
A study led by the European Network for the Investigation of Gastrointestinal Mucosal Alterations found inconsistent compliance with EGD biopsy–sampling guidelines in patients with signs of gastric pathology, even in academic centers. The authors of that study recommended dedicated educational programs to raise awareness of which scenarios warrant gastric sampling during EGD.
The authors of the current study also acknowledge that many sound practices that likely improve quality, for instance time-outs or checklists for administering antibiotics during percutaneous feeding tube placement, are unlikely to be formally studied.
“Nevertheless, such practices should be encouraged and monitored,” they wrote.
“This document synthesizes practices and interventions that may allow for a high-quality upper endoscopy,” they concluded. “Furthermore, the scarcity of strong data to support interventions that can improve important quality indicators in upper-GI endoscopy should be seen as an opportunity.”
Several authors disclosed relationships with commercial interests, such as Boston Scientific, Salix, and Janssen. Buckles reports no relevant financial relationships.
This story originally appeared on MDedge.com, part of the Medscape Professional Network.
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