Common endoscopic procedure requires improved quality indicators

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One of the most common procedures in gastroenterology – esophagogastroduodenoscopy (EGD) – must consistently meet quality measures, but data on interventions to improve them are lacking, according to a recent review.

The researchers, led by Fateh Bazerbachi, MD, with CentraCare, Interventional Endoscopy Program, at St. Cloud’s Hospital (Minn.) performed a systematic review of the literature to identify interventions and measures that improved performance EGD quality indicators previously identified by the American Society for Gastrointestinal Endoscopy. They also looked for evidence of improved compliance with priority indicators. The review appeared in Gastrointestinal Endoscopy.

The authors pointed out that more than 6.1 million EGDs are performed each 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 essential to achieve consistent results.

Daniel C. Buckles, MD, associate professor of gastroenterology, hepatology, and motility at the University of Kansas Medical Center in Kansas City, who was not part of the review, said high EGDs are essential for many reasons, including avoiding overuse when the results of the procedure are unlikely to change a patient’s treatment, but add risk to the patient and increase costs to the healthcare system .

“The lack of training to recognize significant gastrointestinal pathologies seen on an EGD and the lack of standardized reporting of gastrointestinal abnormalities using validated classification systems may lead to suboptimal treatment and follow-up for patients,” he noted.

Testing provider adherence to guidelines years after they were released helps providers understand what works and can improve outcomes, Buckles said.

Buckles said one of the highlights of the review was that the researchers were able to say with confidence that the use of standardized checklists and frequent audits had value for improving quality indicators. pre-procedural and post-procedural.

“The authors also concluded that targeted educational interventions could improve endoscopists’ abilities to adhere to standardized Barrett’s esophagus examinations,” he added. “Unfortunately, the authors were unable to find much evidence of interventions that would improve intra-procedural EGD quality indicators.”

The authors highlighted a prospective study that assessed whether an audit intervention helped in 10,000 consecutive EGDs. They found that the audits “improved the quality of the EGD report, such as substantiating incompleteness or accurately describing the lesion/segment, regardless of the endoscopist’s experience in documenting the report (specialist versus trainee )”. When audits were used in other studies to assess overall endoscopy performance (including EGD and colonoscopy), results showed similar improvement in important endpoints, the authors wrote. Additionally, “the use of dictation templates has been shown to improve the completeness of the endoscopy report.”

A study conducted by the European Network for the Investigation of Alterations of the Gastrointestinal Mucosa found inconsistent compliance with EGD biopsy sampling guidelines in patients with evidence of gastric pathology, even in academic centers. The authors of this study recommended dedicated educational programs to raise awareness of the scenarios warranting gastric harvesting during EGD.

The authors of the present study also acknowledge that many good practices that can improve quality, such as withdrawal times or checklists for administering antibiotics during catheter placement percutaneous feeding, are unlikely to be formally studied.

“Nevertheless, such practices should be encouraged and monitored,” they wrote.

“This document summarizes the practices and interventions that can enable high-quality endoscopy,” they concluded. “Furthermore, the paucity of strong data to support interventions that may improve important quality indicators in upper gastrointestinal endoscopy should be viewed 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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