Yang L.S.1, Thompson A.J.V.1, Taylor A.C.F.1, Desmond P. 1, Holt B.A.1
1Department of Gastroenterology, St Vincent's Hospital, Melbourne and the University of Melbourne, Australia
Background/Aims: Upper gastrointestinal endoscopy (UGIE) is a widely utilised diagnostic and therapeutic procedure, and quality assurance is crucial to ensure safety, efficacy and cost-effectiveeness. The European Society of Gastrointestinal Endoscopy (ESGE) and the British Society of Gastroenterology (BSG) have published recommended performance measures. We aimed to evaluate i) detection rate of Barrett
Methods: This study was conducted at a tertiary hospital between July 2018 and July 2019. Patient demographics and procedural information were extracted from medical records. Endoscopic findings and images were recorded from endoscopy reports. Corresponding histology reports were reviewed to record biopsy practices and histological diagnoses.
Results: 1699 diagnostic gastroscopy procedures performed by 44 endoscopists was analysed. The prevalence of new diagnoses of BE, SD and GIM were 2.7%, 0.1%, and 6%, respectively. Seattle protocol biopsies were obtained in 65% (72/133) of BE. Lugol chromoendoscopy was performed in 6% (9/143) of at risk patients for squamous cell carcinoma (SCC). Sydney protocol biopsies were performed in 35% (55/155) of GIM. The only performance measure associated with higher rate of detection of all pre-malignant pathologies was longer procedure time (median 10min vs 8min, OR 1.09 [95% CI 1.03-1.15]). Adherence to BSG guidelines was poor.
Conclusion: This is the first Australian study evaluating adherence to published quality metrics of UGIE and its association with diagnostic yield. Despite suboptimal adherence to guidelines, longer procedure time improved detection rates of clinically significant pathology. Unlike in colonoscopy, a program for measuring and improving quality metrics in UGIE does not exist. We recommend the development of Australian guidelines and an educational program to improve quality of UGIE.
Keywords: Quality, Gastroscopy, Barrett's esophagus, Esophageal squamous dysplasia, Gastric intestinal metaplasia