Endoscopic Ultrasound Quality Metrics in Clinical Practice.

Lawrence Ku,Viktor E Eysselein,Linda A Hou,Sofiya Reicher

doi:10.3390/diagnostics11020242

Abstract

Recent advances in endoscopic ultrasound (EUS), particularly EUS-guided tissue acquisition, may have affected EUS procedural performance as measured by current American Society for Gastrointestinal Endoscopy (ASGE)/American College of Gastroenterology (ACG) quality indicators. Our study aims to assess how these quality metrics are met in clinical practice. We retrospectively analyzed 732 EUS procedures; data collected were procedural indications, technical aspects and outcomes, completeness of documentation, and malignancy staging. EUS was performed in 660 patients for a variety of indications. All ASGE/ACG EUS procedural quality metrics were met or exceeded. Intervention was successful in 97.7% (715/732) of cases, with complication rate of 0.4% (3/732). EUS outcomes changed clinical management in 58.7% of all cases and in 91.2% of malignancy work-up cases; in 26.0% of suspected choledocholithiasis cases, endoscopic retrograde cholangiopancreatography (ERCP) was avoided after EUS. Locoregional EUS staging was accurate in 61/65 (93.8%) cases of non-metastatic disease and in 15/22 (68.2%) cases of metastatic disease. Pancreatic mass malignancy detection rate with EUS-guided fine needle aspiration (FNA) or fine needle biopsy (FNB) was 75.8%, with a sensitivity of 96.2%; a significant increase in detection rate from 46.2% (6/13) to 95.0% (19/20) (p = 0.0026) was observed with a transition to the predominant use of FNB for tissue acquisition. All ASGE/ACG EUS quality metrics were met or exceeded for EUS procedures performed for a wide variety of indications in a diverse patient population. EUS was instrumental in changing clinical management, with a low complication rate. The malignancy detection rate in pancreatic masses significantly increased with FNB use.

Highlights

Endoscopic ultrasound (EUS) is an indispensable modality for diagnosis of various gastrointestinal (GI) pathologies [1,2,3]
Priority has been given to three specific indicators: appropriate GI cancer staging, diagnostic rates of malignancy and sensitivity for EUS-guided fine needle aspiration (FNA) (EUSFNA) of pancreatic masses, and incidence of adverse events after EUS-FNA
Recent American Society for Gastrointestinal Endoscopy (ASGE) guidelines on the management of choledocholithiasis recognized that earlier (2010) guidelines for proceeding directly to endoscopic retrograde cholangiopancreatography (ERCP) for patients stratified to a high probability of choledocholithiasis were neither sensitive nor specific enough; the clinical management algorithm has been updated in 2019 to incorporate modalities such as EUS [6,7]

Summary

Introduction

Endoscopic ultrasound (EUS) is an indispensable modality for diagnosis of various gastrointestinal (GI) pathologies [1,2,3]. Priority has been given to three specific indicators: appropriate GI cancer staging, diagnostic rates of malignancy and sensitivity for EUS-guided FNA (EUSFNA) of pancreatic masses, and incidence of adverse events after EUS-FNA. Recent ASGE guidelines on the management of choledocholithiasis recognized that earlier (2010) guidelines for proceeding directly to endoscopic retrograde cholangiopancreatography (ERCP) for patients stratified to a high probability of choledocholithiasis were neither sensitive nor specific enough; the clinical management algorithm has been updated in 2019 to incorporate modalities such as EUS [6,7]. Recent advances in EUS, such as FNB, call for an assessment of EUS performance in clinical practice in relation to the current quality indicators. We evaluate how our EUS practice adheres to and meets the ASGE/ACG quality metrics, and whether EUS has been instrumental in clinical management

Materials and Methods

Demographics and Procedure Metrics

Indications

Outcomes

Discussion