Endoscopist biopsy rate as a quality indicator for outpatient gastroscopy: a multicenter cohort study with validation

Januszewicz, Władysław; Wieszczy, Paulina; Białek, Andrzej; Karpińska-Kaczmarczyk, Katarzyna; Szlak, Jakub; Szymonik, Jakub; Rupiński, Maciej; Mróz, Andrzej; Reguła, Jarosław

doi:10.1016/j.gie.2019.01.008

Cited by 42 publications

(45 citation statements)

References 23 publications

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“…It could be a outcome measure of EGD, which is comparable to the withdrawal time of colonoscopy; however, it is based only on limited evidence, and the cutoff procedure time varied from 3 to 7 minutes for EGD 212223. Biopsy rate could be considered as a quality indicator of EGD, as it has been shown to be associated with efficacy in gastric premalignant conditions, as well as with the rate of missed gastric cancers 24. However, it was not different among the different healthcare facility types.…”

Section: Discussionmentioning

confidence: 99%

Quality Indicators and Outcome Measures of Endoscopy in the National Cancer Screening Program

et al. 2019

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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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Section: Discussionmentioning

confidence: 99%

Quality Indicators and Outcome Measures of Endoscopy in the National Cancer Screening Program

et al. 2019

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“…All were Japanese Gastroenterological Endoscopy Society board certified. We calculated the endoscopist biopsy rate (EBR) [9] and detection rate of gastric cancer, esophageal cancer, gastric adenoma, and duodenal adenoma for each endoscopist. EBR was calculated as the percentage of EGDs with at least one biopsy specimen for histology from esophagus, stomach, or duodenum, and was classified into four groups (low, moderate, high, and very high) by its quartile range.…”

Section: Methodsmentioning

confidence: 99%

“…In addition to these confounders, we also considered EBR as a possible confounder because EBR was recently reported as a ▶ Table 2 Characteristics of endoscopists in terms of biopsy rate and disease detection rate. quality indicator of EGD [9], and endoscopists with long examination times were reported to take more biopsies during EGD [31]. The propensity score-matched method [32] is a useful method to reduce bias especially when the event is rare [33].…”

Section: Scopolaminementioning

confidence: 99%

Noneffectiveness of scopolamine for facilitating detection of upper gastrointestinal neoplasia during screening esophagogastroduodenoscopy: propensity score-matched study

et al. 2020

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Background Antispasmodics, such as scopolamine, are widely used in several countries prior to diagnostic and screening esophagogastroduodenoscopy (EGD), with the goal of optimizing the detection of minute lesions, typically early gastric cancer (T1 lesions). The aim of this study was to determine whether scopolamine facilitates detection of gastric cancer in the screening setting. Methods A propensity score-matched retrospective study was conducted in a tertiary referral medical center in Tokyo, Japan. Consecutive individuals (n = 40 776) underwent screening EGD between January 2011 and May 2016. All outcome lesions were diagnosed with histopathological confirmation. Detection of esophageal cancer, gastric adenoma, duodenal adenoma, and upper gastrointestinal neoplasia (UGIN) were investigated as secondary outcomes. Results Scopolamine was used in 31 130 patients (76.3 %) and propensity score matching yielded 6625 pairs. Bivariate analysis revealed no significant association between possible confounders (age, sex, overweight, atrophic gastritis, alcohol history, smoking history, midazolam use, endoscopist biopsy rate grade, and gastric cancer in first-degree relatives) and scopolamine use. Lesions detected were 18 gastric cancers, 11 esophageal cancers, 19 gastric adenomas, 6 duodenal adenomas, and 54 UGINs, with no significant association between scopolamine use and lesion detection. Conclusions Scopolamine use did not appear to effectively facilitate detection of gastric or esophageal cancer, gastric or duodenal adenoma, and UGIN during screening EGD. Scopolamine should be avoided until its efficacy is confirmed by a randomized controlled trial.

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“…A retrospective analysis of data from 111,962 individuals who underwent upper endoscopy as part of a The decision to perform a biopsy, the number of biopsies, and the location of biopsies performed on upper endoscopy must take into account cost considerations. As Januszewicz et al 2 show, although high-EBR endoscopists have higher rates of GPC detection and lower rates of GC misses, they also have a higher negative biopsy rate.…”

mentioning

confidence: 98%

“…The decision to perform a biopsy, the number of biopsies, and the location of biopsies performed on upper endoscopy must take into account cost considerations. As Januszewicz et al 2 show, although high-EBR endoscopists have higher rates of GPC detection and lower rates of GC misses, they also have a higher negative biopsy rate. The prevalence of GPCs and incidence of GC can vary widely between different regions of the world and also between ethnic and racial groups within a given region.…”

mentioning

confidence: 98%

Routine gastric biopsies: Should we be doing more?

Huang

Hwang

2019

Gastrointestinal Endoscopy

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Endoscopist biopsy rate as a quality indicator for outpatient gastroscopy: a multicenter cohort study with validation

Abstract: Endoscopists with higher EBR (≥43.8%) had a lower risk of missed cancer as compared with lower EBR group (OR=0.44; 95% CI, 0.20-1.00; P=.049). ConclusionsThe EBR parameter is highly variable among endoscopists, associated with efficacy in GPC detection and the rate of missed GCs.

Cited by 42 publications

References 23 publications

Quality Indicators and Outcome Measures of Endoscopy in the National Cancer Screening Program

Quality Indicators and Outcome Measures of Endoscopy in the National Cancer Screening Program

Noneffectiveness of scopolamine for facilitating detection of upper gastrointestinal neoplasia during screening esophagogastroduodenoscopy: propensity score-matched study

Routine gastric biopsies: Should we be doing more?

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