Division of Gastroenterology and Hepatology, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA.
GI Quality Improvement Consortium, Bethesda, Maryland, USA.
Gastrointest Endosc. 2019 Nov;90(5):732-741.e3. doi: 10.1016/j.gie.2019.04.250. Epub 2019 May 11.
Guidelines recommend systematic biopsy sampling in Barrett's esophagus (BE) to reduce sampling error. Adherence to this biopsy sampling protocol has been suggested as a quality indicator; however, estimates of adherence are not available. Using a national registry, we assessed adherence and identified predictors of adherence to biopsy sampling protocols.
We analyzed data from the GI Quality Improvement Consortium Registry that included procedure indication, demographics, endoscopy, and pathology results. Patients with an indication of BE screening/surveillance or an endoscopic finding of BE were included. Adherence to the Seattle protocol was assessed by dividing BE length by number of pathology jars, with a ratio ≤2.0 with rounding down (lenient definition) or rounding up (stringent definition) for odd BE lengths considered adherent. Variables associated with adherence were assessed using generalized estimating equations to control for clustering within individual physicians.
Of 786,712 EGDs assessed, 58,709 (7.5%) EGDs in 53,541 patients met inclusion criteria (mean age, 61.3 years; 60.4% men; 90.2% white; mean BE length, 2.3 cm). When the lenient and stringent definitions for adherence were used, 87.8% and 82.7% of EGDs were adherent, respectively. Increasing BE length was the most significant predictor of nonadherence (odds ratio, .69; 95% confidence interval, .67-.71). Other predictors were increasing age, male gender, increasing American Society of Anesthesiologists class, and practice location. Performance of EGD by nongastroenterologist physicians was associated with nonadherence (odds ratio, .07; 95% confidence interval, .06-.10).
Nearly 20% of endoscopies performed in BE patients were not adherent to the Seattle protocol. As BE length increases, endoscopists become less compliant with odds of nonadherence increasing by 31% with every 1-cm increase in length.
指南建议在 Barrett 食管（BE）中进行系统活检采样，以减少采样误差。遵守这种活检采样方案被认为是一个质量指标；然而，目前尚不清楚其遵守率。本研究使用国家注册中心，评估了依从性，并确定了遵守活检采样方案的预测因素。
我们分析了 GI 质量改进联盟注册中心的数据，其中包括手术指征、人口统计学、内镜和病理结果。包括 BE 筛查/监测的适应证或内镜发现 BE 的患者。通过将 BE 长度除以病理瓶数来评估对西雅图方案的依从性，BE 长度为奇数时采用向下舍入（宽松定义）或向上舍入（严格定义）的方法，认为符合长度比≤2.0。使用广义估计方程评估与依从性相关的变量，以控制个别医生之间的聚类。
在评估的 786712 例 EGD 中，53541 例患者的 58709 例 EGD（平均年龄 61.3 岁；60.4%为男性；90.2%为白人；平均 BE 长度 2.3cm）符合纳入标准。当使用宽松和严格的依从性定义时，分别有 87.8%和 82.7%的 EGD 是依从的。BE 长度的增加是不依从的最重要预测因素（比值比，.69；95%置信区间，.67-.71）。其他预测因素包括年龄增加、男性、美国麻醉医师协会分级增加和执业地点。非胃肠病医生行 EGD 与不依从相关（比值比，.07；95%置信区间，.06-.10）。
在 BE 患者中进行的近 20%的内镜检查不符合西雅图方案。随着 BE 长度的增加，内镜医生的依从性降低，BE 长度每增加 1cm，不依从的可能性增加 31%。
