Composite detection rate as an upper gastrointestinal endoscopy quality measure correlating with detection of neoplasia

Abstract

Background Esophagogastroduodenoscopy (EGD) is commonly used diagnostic method with no widely accepted quality measure. We assessed quality indicator—composite detection rate (CDR)—consisting of detection of at least one of the following: cervical inlet patch, gastric polyp and post-ulcer duodenal bulb deformation. The aim of the study was to validate CDR according to detection rate of upper gastrointestinal neoplasms (UGN). Methods It was a multicenter, prospective, observational study conducted from January 2019 to October 2019. The endoscopic reports from 2896 symptomatic patients who underwent diagnostic EGD were analyzed. The EGDs were performed in three endoscopy units located in tertiary university hospital, private outpatient clinic and local hospital. Results 64 UGNs were detected. The mean CDR was 21.9%. The CDR correlated with UGN detection rate (R = 0.49, p = 0.045). Based on CDR quartiles, operators were divided into group 1 with CDR < 10%, group 2 with CDR 10–17%, group 3 with CDR 17.1–26%, and group 4 with CDR > 26%. Detection rate of UGN was significantly higher in the group 4 in comparison to group 1 (OR 4.4; 95% CI 2.2 − 9.0). In the multivariate regression model, patient age, male gender and operator’s CDR > 26% were independent risk factors of UGN detection (OR 1.03; 95% CI 1.01 − 1.05, OR 2; 95% CI 1.2 − 3.5, and OR 5.7 95% CI 1.5 − 22.3, respectively). Conclusions The CDR is associated with the detection of upper gastrointestinal neoplasms. This parameter may be a useful quality measure of EGD to be applied in general setting.

The relation of esophagogastroduodenoscopy time and novel upper gastrointestinal quality measures

“…Our findings regarding higher biopsy rate, higher CDR with increasing procedure time as well as a lower rate of EGDs without pathology diagnosed and higher UGN detection among slower procedures seem to reflect the increasing high-risk gastric lesions (intestinal metaplasia, gastric atrophy, gastric dysplasia, and cancer) and neoplastic lesions in the upper digestive tract detection with operator's longer mean examination time without the biopsy demonstrated in other data [9][10][11]. In contrast to EBR which was validated based on gastric interval cancers, CDR was evaluated for the detection of any upper gastrointestinal neoplasia [5,13]. In the studies assessing the procedure time, it has been evaluated based on similar endpoints [10][11][12].…”

“…In this setting, the ‘operator-based’ analysis was not suitable. Also, because of the low prevalence of neoplastic lesions in the Polish population and a low number of operators the impact operator’s mean EGD duration on neoplasia detection could not be properly evaluated [5]. Also, the comparison of EBR and procedure time could be biased by the time that was spent not on lesions assessment but only on biopsy itself.…”

“…Recently, it has been shown that EBR was related to lower rate of interval gastric cancer; however, this measure was not correlated with the gastric dysplasia detection [13]. Another recently proposed quality measure – the CDR correlated with the detection of dysplastic lesions in the esophagus, stomach, and duodenum [5]. Previously, other quality measures such as Vater’s ampulla photodocumentation or scoring system taking into account gastric diverticula and subepithelial lesions were assessed [18,19].…”

“…Also, further analysis of selected procedures without biopsy obtained could be time-consuming. Recently, two new quality indicators were proposed, namely endoscopy biopsy rate (EBR – ratio of examinations with at least one biopsy obtained for histopathological assessment) and composite detection rate (CDR – consisting of the detection of cervical inlet patch, gastric polyp, and post-ulcer duodenal bulb deformation) [5,13]. The aim of this study was to determine whether the EGD duration measurement is an optimal quality measurement when compared with recent indicators – EBR and CDR.…”

“…Therefore various quality measures have been proposed [1,3,4]. Because of different neoplastic lesions, the development process in the esophagus, stomach and duodenum, and their relatively low prevalence no 'direct' quality measure such as adenoma detection rate for colonoscopy was established for EGD [5,6]. The endoscopy time is a known quality standard of the lower gastrointestinal tract endoscopy [6,7].…”