Soudagar A Samad, Nguyen Minh, Bhatia Arvin, Rastogi Amit, Gupta Neil
*Division of Gastroenterology and Nutrition, Loyola University Medical Center, Maywood, IL †Division of Gastroenterology and Hepatology, Veterans Affairs Medical Center, Kansas City, MO ‡Division of Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, KS.
J Clin Gastroenterol. 2016 May-Jun;50(5):e45-9. doi: 10.1097/MCG.0000000000000382.
To determine whether gastroenterologists would be willing to accept the "predict, resect, and discard" strategy for diminutive colorectal polyps and identify potential barriers to implementation in clinical practice.
The ASGE recently published a Preservation and Incorporation of Valuable Endoscopic Innovations (PIVI) document on managing diminutive colorectal polyps using the "predict, resect, and discard" strategy. However, there is no data on whether gastroenterologists would accept this paradigm shift.
We performed a random survey of gastroenterologists at a national meeting. Awareness of and willingness to adopt the "predict, resect, and discard" practice, reasons for not utilizing it, and whether a financial incentive would be persuasive in implementing the practice were assessed.
A total of 105 gastroenterologists were surveyed. Seventy-six (72%) were aware of the PIVI statement and 64 (61%) stated they would be willing to implement this in practice. Medical-legal concerns (85%) and lack of financial incentives (32%) were the 2 most commonly cited barriers to implementation. Greater than 50% of those resistant to performing the service would be willing do so if given a financial incentive, with ∼50% of gastroenterologists who cited an appropriate incentive preferring >$75 to do so. Of these, private practice gastroenterologists and those who had financial interest in sending polyps to pathology were the most likely to request this amount.
Approximately two-thirds of gastroenterologists are willing to adopt the "predict, resect, and discard" strategy for managing diminutive colon polyps. Medical-legal concerns and lack of financial incentives are the primary barriers to implementation.
确定胃肠病学家是否愿意接受针对微小结直肠息肉的“预测、切除并丢弃”策略，并识别临床实践中实施该策略的潜在障碍。
美国胃肠内镜学会（ASGE）最近发布了一份关于使用“预测、切除并丢弃”策略管理微小结直肠息肉的《保留与纳入有价值的内镜创新（PIVI）》文件。然而，尚无关于胃肠病学家是否会接受这一范式转变的数据。
我们在一次全国性会议上对胃肠病学家进行了随机调查。评估了对“预测、切除并丢弃”做法的知晓情况和采用意愿、不采用的原因，以及经济激励措施在实施该做法时是否具有说服力。
共调查了105名胃肠病学家。76人（72%）知晓PIVI声明，64人（61%）表示愿意在实践中实施。医疗法律方面的担忧（85%）和缺乏经济激励（32%）是最常被提及的实施障碍。超过50%拒绝提供该服务的人在给予经济激励后愿意这样做，约50%提到适当激励措施的胃肠病学家希望激励金额超过75美元才愿意这样做。其中，私人执业的胃肠病学家以及那些将息肉送检病理有经济利益的人最有可能要求这一金额。
约三分之二的胃肠病学家愿意采用“预测、切除并丢弃”策略来管理微小结肠息肉。医疗法律方面的担忧和缺乏经济激励是实施的主要障碍。
