Adherence to Quality Indicators for Diagnosis and Surveillance of Barrett's Esophagus: A Comparative Study of Barrett's Experts and Nonexperts

Abstract

Background and AimsThere is considerable variability in adherence to endoscopic quality indicators (QIs) for Barrett's esophagus (BE). The aims of this study were to (1) assess adherence to published Qis for diagnosis and surveillance of BE, (2) compare adherence between BE experts and nonexperts, and (3) identify factors associated with adherence. MethodsWe identified all patients with BE on esophagogastroduodenoscopy between 2010 and 2018. QIs evaluated included inspection using high-definition white light endoscopy, use of the Prague Classification, identification of endoscopic landmarks, use of the Seattle Protocol, and guideline-adherent recommendations for surveillance or endoscopic eradication therapy. BE experts and nonexperts were compared using logistic mixed-effects models. ResultsA total of 467 patients were identified, with BE experts performing fewer overall esophagogastroduodenoscopies (n = 162, 34.7% vs n = 305, 65.3%). Whereas BE experts were more likely to document Prague Classification (52.5% vs 41.3%; P = 0.017) and landmarks (43.2% vs 22.6%; P = 0.036), there was no significant difference between experts and nonexperts in use of high-definition white light endoscopy (8.6% vs 3.3%; P = 0.123), Seattle Protocol (48.1% vs 40.3%; P = 0.313), or guideline-adherent surveillance or treatment recommendations (71.0% vs 67.5%; P = 0.509). Patient enrollment in a BE surveillance program was the only factor associated with improved QI adherence, specifically adherence to Prague Classification documentation (OR 1.85, 95% CI 1.08-3.14; P = 0.025), Seattle Protocol (1.28, 95% CI 1.16-1.50; P < 0.001), and follow-up recommendations (OR 2.64, 95% CI 1.55-4.48; P < 0.001). ConclusionPatterns of adherence to published QIs for endoscopy in patients with BE are mostly independent of expertise. Further training initiatives are needed to standardize the performance of endoscopic practice in patients with BE.