Practice patterns in screening for varices: An American survey

Abstract

Background and aims Guidelines recommend screening for gastroesophageal varices. Regional studies suggest screening is underutilized, but information from across the United States is unavailable. We explored practice patterns and adherence to guidelines in a random sample of physicians and sought to define whether differences existed according to practice type, setting and years of practice. Materials and Methods Surveys were randomly sent to 600 gastroenterologists and hepatologists. Descriptive data is presented as percentage and comparisons were performed by chi-square analysis. Significance was defined at a p value <0.05. Results 180 completed surveys were returned. Mean age was 48.9 ± 10 years and 87% were male. 50% were community-based and 74% had been in practice >10 years. 53% (78% hepatologists versus 45% of gastroenterologists) screened consistently (>75% of the time), (p < 0.001). No differences in screening frequency were found according to practice setting or years in practice. 62% screened all cirrhotics whereas 38% screened based on clinical characteristics. In patients without gastroesophageal varices, 60% repeated esophagogastroduodenoscopy in 2–3 years. In those with small gastroesophageal varices, repeat esophagogastroduodenoscopy was recommended in 1–2 years by 73%. In patients with small and large varices, 40% and 54% of physicians respectively, recommended prophylaxis. 6% of physicians recommend prophylaxis regardless of the presence or size of varices. Conclusions Screening for varices is under-implemented. Many screened based on clinical findings that have not been shown to reliably predict high-risk gastroesophageal varices. Continued education and removal of financial barriers to screening are central to increasing screening rates and improving patient outcomes.

Role of portal haemodynamic parameters in prediction of oesophageal varices in cirrhotic patients

“…In patients with normal liver tests, endoscopic screening is advised every 2 years, and in cirrhotic patients with abnormal liver tests it is advised every 12 months. In addition, in patients with small varices, endoscopy should be planned once a year [5]. Routine endoscopic screening of all cirrhotic patients with or without varices has health-service cost implications.…”

The detection of oesophageal varices using a novel, disposable, probe‐based transnasal endoscope: a prospective diagnostic pilot study

“…Hence, TNE procedures have, so far, been performed in the endoscopy unit and not routinely used for OV screening, possibly because endoscopists perceive little added value in performing TNE when C‐OGD is readily available and can simultaneously be utilized for variceal band ligation if necessary . Screening for OV using C‐OGD is reportedly under‐implemented in clinical practice, in particular, within the community hospitals setting . Hepatologists were more likely to screen patients compared to general gastroenterologists and more likely to initiate primary prophylaxis .…”

“…Screening for OV using C‐OGD is reportedly under‐implemented in clinical practice, in particular, within the community hospitals setting . Hepatologists were more likely to screen patients compared to general gastroenterologists and more likely to initiate primary prophylaxis .…”

“…Hepatologists were more likely to screen patients compared to general gastroenterologists and more likely to initiate primary prophylaxis (23). The EG Scan may address these limitations by offering a portable and disposable endoscopic imaging tool that can be used as a pre-screening test in the office to reduce the number of unnecessary endoscopies and potentially improve screening uptake by offering a welltolerated and more preferred test to patients.…”

Overutilization of endoscopic surveillance in nondysplastic Barrett's esophagus: a multicenter study

“…In a study of utilization of upper endoscopy for gastric ulcers in the US, Saini et al found that 25% of ambulatory patients with gastric ulcer had “surveillance EGDs” within 3 months of the index endoscopy (presumably to document ulcer healing), despite the fact that this practice has not been shown to improve outcomes and is not generally recommended [31]. In addition, wide variation in practice patterns and guideline adherence has been described in inflammatory bowel disease [32–34], liver disease [35, 36], and colorectal cancer screening practices [37, 38] in the US. Our study provides further evidence that within the field of gastroenterology, there exists variation in care, with some patients getting too much.…”