Adherence to quality indicators in endoscopic surveillance of Barrett's esophagus and correlation to dysplasia detection rates

Background and aims: The American Gastroenterological Association introduced quality guidelines for the endoscopic management of Barrett's esophagus (BE) in 2015. Our aim was to determine if these guidelines are being followed and to correlate adherence with outcomes in surveillance endoscopy. Methods: This is a retrospective study from December 2015 to June 2017. Charts were abstracted to determine if the recommended quality measures were successfully accomplished during surveillance endoscopic exams in BE. Five of the recommendations pertain to surveillance endoscopy. Findings: One hundred and seventy-four patients with Barrett's esophagus who underwent endoscopic surveillance were included. Adherence to recommendations one (78%), two (70%), six (99%), and seven (95%) were generally observed (P< 0.001) but not to recommendation five (41%). When recommendations one (documenting important landmarks) and two (documenting the Prague classification) were followed, there was a statistically significant increase in dysplasia detection compared with those that did not adhere to the recommendations (36% vs. 13%, P=0.006 and 36% vs. 19%, P=0.003). The odds of detecting dysplasia when recommendations one and two were followed were 3.7 (95% CI 1.37-10.2) and 2.4 (95% CI 1.1-5.2) respectively. Conversely, there was no statistical difference in dysplasia yield for adherers compared with non-adherers to statement five (if systematic biopsies were performed; 35% vs. 27%, P=0.3). Conclusion: Adherence to statements one and two resulted in higher dysplasia detection. This has implications for the use of quality indicators in BE management in endoscopy units. (C) 2018 Elsevier Masson SAS. All rights reserved.