Adherence to recommendations of Barrett's esophagus surveillance guidelines: a systematic review and meta-analysis.

Abstract

Guidelines aim to reduce treatment variation and improve quality of care. In the literature there is large variation in the reported rates of adherence to recommendations of surveillance for Barrett's esophagus (BE). The aim of this systematic review was to identify explanatory parameters determining these differences in adherence rates. Embase, Medline Epub, and Web of Science were searched. Studies reporting adherence in at least one of five domains were selected: general domain, surveillance interval, biopsy protocol, landmark identification, and histopathological information. Adherence was expressed as the proportion of endoscopies or endoscopists being in accordance with guideline recommendations. Variation in adherence was evaluated by 1) meta-regression of adherence rates in random effects meta-analysis to define subgroups, and 2) compiling an overview of the most reported explanatory parameters for (non)adherence. 56 studies, including 14 002 BE patients and 4932 endoscopists, were included. Subgroup analysis showed that variation in rates of adherences to surveillance interval recommendations (I 2 = 98 % - 99 %) was explained by difference in country (43 %), by practice type (90 %), and by year of publication (11 %). Variation in adherence to the Seattle protocol was explained by difference in country (14 %). Factors most frequently reported to be associated with better adherence were shorter BE length, salaried employment, surveillance in university hospitals, and dedicated programs. This study provides insight into the variability of rates of adherence to BE surveillance recommendations between studies. Better adherence in university hospitals and dedicated programs indicate that persistent alertness of guidelines is important.