提高美国学术医疗机构胃肠病学家遵循胃黏膜肠上皮化生临床实践指南的能力。
Improving Adherence to Clinical Practice Guidelines for Managing Gastric Intestinal Metaplasia Among Gastroenterologists at a US Academic Institution.
机构信息
Section of Gastroenterology and Hepatology.
Houston Methodist Gastroenterology Associates.
出版信息
J Clin Gastroenterol. 2024;58(5):432-439. doi: 10.1097/MCG.0000000000001890. Epub 2023 Jul 13.
BACKGROUND
Clinical guidelines reserve endoscopic surveillance after a gastric intestinal metaplasia (GIM) diagnosis for high-risk patients. However, it is unclear how closely guidelines are followed in clinical practice. We examined the effectiveness of a standardized protocol for the management of GIM among gastroenterologists at a US hospital.
METHODS
This was a preintervention and postintervention study, which included developing a protocol and education of gastroenterologists on GIM management. For the preintervention study, 50 patients with GIM were randomly selected from a histopathology database at the Houston VA Hospital between January 2016 and December 2019. For the postintervention study, we assessed change in GIM management in a cohort of 50 patients with GIM between April 2020 and January 2021 and surveyed 10 gastroenterologists. The durability of the intervention was assessed in a cohort of 50 GIM patients diagnosed between April 2021 and July 2021.
RESULTS
In the preintervention cohort, GIM location was specified (antrum and corpus separated) in 11 patients (22%), and Helicobacter pylori testing was recommended in 11 of 26 patients (42%) without previous testing. Gastric mapping biopsies were recommended in 14% and surveillance endoscopy in 2%. In the postintervention cohort, gastric biopsy location was specified in 45 patients (90%, P <0.001) and H. pylori testing was recommended in 26 of 27 patients without prior testing (96%, P <0.001). Because gastric biopsy location was known in 90% of patients ( P <0.001), gastric mapping was not necessary, and surveillance endoscopy was recommended in 42% ( P <0.001). One year after the intervention, all metrics remained elevated compared with the preintervention cohort.
CONCLUSIONS
GIM management guidelines are not consistently followed. A protocol for GIM management and education of gastroenterologists increased adherence to H. pylori testing and GIM surveillance recommendations.
背景
临床指南为高风险患者保留了胃肠上皮化生（GIM）诊断后的内镜监测。然而，目前尚不清楚在临床实践中指南的遵循程度如何。我们研究了美国一家医院的胃肠病学家对 GIM 管理的标准化方案的有效性。
方法
这是一项干预前后研究，包括制定方案和对胃肠病学家进行 GIM 管理教育。在干预前研究中，从 2016 年 1 月至 2019 年 12 月，休斯顿退伍军人事务医院的组织病理学数据库中随机选择了 50 例 GIM 患者。在干预后研究中，我们评估了 2020 年 4 月至 2021 年 1 月期间 GIM 管理在 50 例 GIM 患者中的变化，并对 10 名胃肠病学家进行了调查。在 2021 年 4 月至 2021 年 7 月期间诊断的 50 例 GIM 患者队列中评估了干预的持久性。
结果
在干预前队列中，11 例（22%）患者明确了 GIM 部位（胃窦和胃体分开），26 例（42%）无既往检测的患者建议进行幽门螺杆菌检测。14%的患者建议进行胃活检，2%的患者建议进行内镜监测。在干预后队列中，45 例（90%，P <0.001）患者明确了胃活检部位，27 例无既往检测的患者建议进行 H. pylori 检测（96%，P <0.001）。由于 90%的患者（P <0.001）胃活检部位已知，因此不需要进行胃活检，建议进行内镜监测（42%，P <0.001）。干预一年后，所有指标与干预前队列相比均升高。
结论
GIM 管理指南并未得到一致遵循。GIM 管理方案和对胃肠病学家的教育增加了对 H. pylori 检测和 GIM 监测建议的依从性。
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