P0324 - Variable Adherence Rates to Appropriate Surveillance Intervals and Seattle Biopsy Protocol in Barrett’s Esophagus (BE): An Analysis Using the GIQuIC National Quality Benchmarking Registry

Sachin Wani, MD¹, J. Lucas Williams, MPH², Jennifer Holub, MPH², Christian Davis, MD³, Jennifer Kolb, MD, MS⁴, Nicholas Shaheen, MD^5
1University of Colorado Anschutz Medical Campus, Aurora, CO; ²GI Quality Improvement Consortium, Bethesda, MD; ³University of Colorado School of Medicine, Denver, CO; ⁴University of California Irvine, Orange, CA; ⁵University of North Carolina at Chapel Hill, Chapel Hill, NC

Introduction: Adherence to surveillance interval of 3-5 years in non-dysplastic BE (NDBE) patients and the Seattle biopsy protocol (4-quadrant biopsies every 2 cm) have been promoted as quality indicators (QIs) by GI societies. Using a national registry with matched endoscopy and pathology data we evaluated adherence to these QIs across a large group of endoscopists practicing in multiple endoscopy centers.

Methods: We analyzed data from the GI Quality Improvement Consortium (GIQuIC) Registry, a national repository of endoscopy data. Upper endoscopy data on patients with suspected or established BE that included procedure indication, demographics, endoscopy findings, and pathology results were assessed from 1/2018 – 5/2021. Endoscopists and sites had to have submitted at least 10 and 20 EGDs records with suspected/established BE, respectively to be included. Adherence to Seattle protocol was assessed by dividing the BE length by number of pathology jars; a ratio of ≤2.0 with rounding down was considered adherent. Adherence to recommended surveillance for NDBE was calculated by assessing the proportion recommended to undergo an EGD between 3-5 years. The primary outcome was adherence to QIs by endoscopists and secondary outcome was adherence based on practice site.

Results: Of 415,883 EGDs assessed, 20,155 (4.8%) were included [mean age 62.5 yrs (SD 12.7), 61.3% male, 91.5% Caucasian, mean BE length 2.3 (SD 2.8)]. These cases represented 255 practices and 1195 endoscopists nationwide. The distribution of endoscopists based on US census region was: South (n=436, 36.5%), West (n=329, 27.5%), Northeast (n=266, 22.3%), Midwest (n=163, 13.6%). Among endoscopists meeting inclusion criteria (n=572), there was significant variability in adherence rates to Seattle protocol [mean 85.1% (SD 21.6)] and appropriate surveillance in NDBE [mean 70.9% (SD 30)] (Figure). Similar results were noted in site-based analysis (n=153), adherence to Seattle protocol [mean 81.6% (SD 22.7)] and appropriate surveillance in NDBE [mean 68.9% (SD 25.5)]. Adherence rates among endoscopists and sites based on volume of EGDs submitted are shown in Table.

Discussion: Results of this population-based study demonstrate significant variability among endoscopists for established QIs in the management of BE patients. Future efforts are warranted to identify and extinguish causes of this variability, improve adherence rates to QIs among endoscopists doing these exams and assess impact of improving adherence to improved outcomes in BE patients.




Disclosures:


Sachin Wani, MD¹, J. Lucas Williams, MPH², Jennifer Holub, MPH², Christian Davis, MD³, Jennifer Kolb, MD, MS⁴, Nicholas Shaheen, MD⁵. P0324 - Variable Adherence Rates to Appropriate Surveillance Intervals and Seattle Biopsy Protocol in Barrett’s Esophagus (BE): An Analysis Using the GIQuIC National Quality Benchmarking Registry, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.