Adherence to quality indicators and best practices in surveillance endoscopy of Barrett's esophagus: A video-based assessment

Thomas Enke; Rajesh Keswani; Joseph Triggs; Bhargava Gannavarapu; Chetan Mittal; Jasmine Sinha; Mary J Kwasny; Srinadh Komanduri

doi:10.1055/a-2226-3689

Adherence to quality indicators and best practices in surveillance endoscopy of Barrett's esophagus: A video-based assessment

Endosc Int Open. 2024 Jan 19;12(1):E90-E96. doi: 10.1055/a-2226-3689. eCollection 2024 Jan.

Authors

Thomas Enke¹, Rajesh Keswani², Joseph Triggs³, Bhargava Gannavarapu⁴, Chetan Mittal⁵, Jasmine Sinha², Mary J Kwasny⁶, Srinadh Komanduri²

Affiliations

¹ Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, United States.
² Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, United States.
³ Division of Gastroenterology, Fox Chase Cancer Center, Philadelphia, United States.
⁴ Division of Gastroenterology, inSite Digestive Health Care, San Jose, United States.
⁵ Division of Gastroenterology, Aurora St Luke's Medical Center, Milwaukee, United States.
⁶ Department of Preventive Medicine, Division of Biostatistics, Northwestern University Feinberg School of Medicine, Chicago, United States.

Abstract

Background and study aims Adherence to quality indicators (QIs) and best practices (BPs) for endoscopic surveillance of Barrett's esophagus (BE) is low based on clinical documentation which is an inaccurate representation of events occurring during procedures. This study aimed to assess adherence to measurable QI and BP using video evaluation. Methods We performed a single center video-based retrospective review of surveillance endoscopies performed for BE ≥1 cm between March 1, 2018 and October 1, 2020. Adherence to QIs and BPs was assessed through video review and documentation. Videos were evaluated by five gastroenterologists. Interrater variability was determined using 10 videos before reviewing the remaining 128 videos. A generalized linear regression model was used to determine predictors of adherence to QIs and BPs. Results There were 138 endoscopies reviewed. Inspection with virtual chromoendoscopy (VC) occurred in 75 cases (54%) on video review with documentation in 50 of these cases (67%). Adherence to the Seattle protocol (SP) occurred in 74 cases (54%) on video review with documentation in 28 of these cases (38%). Use of VC or the SP was documented but not observed on video review in 16 (12%) and 30 (22%) cases, respectively. Length of BE was associated with increased use of the Prague classification (odds ratio [OR] 1.21, 95% confidence interval [CI] 1.07-1.37) while years in practice was associated with a decreased likelihood of VC use (OR 0.93, 95% CI 0.88-0.99). Conclusions This study validates prior data demonstrating poor adherence to QIs and BPs and highlights discrepancies between clinical documentation and events occurring during procedures.

Keywords: Barrett's and adenocarcinoma; Quality and logistical aspects.

The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).