Sa1459 COMPLIANCE WITH ASGE QUALITY INDICATORS FOR ENDOSCOPIC ULTRASOUND REPORTS IN THE EVALUATION OF PANCREATIC CANCER, COMPARISON OF COMMUNITY AND ACADEMIC PRACTICES

Abstract

The American Society for Gastrointestinal Endoscopy (ASGE) has put forth a list of quality indicators for EUS which evaluate key steps that provide endoscopists targets to provide high quality care. Endoscopist compliance with the ASGE quality indicators has not been well studied in patients who have undergone EUS and subsequent resection for pancreatic cancer. The goal of this study is to evaluate the quality of EUS performed for pancreatic cancer diagnosis and staging in patients who had initial EUS performed at our institution or who had initial EUS performed at an outside institution and were referred to our institution and have subsequently undergone pancreatic cancer resection. Consecutive patients who had EUS for suspected pancreatic cancer and who had subsequently undergone Whipple at a single tertiary care center between 2013 and 2019 were identified by searching an IRB approved surgical database of patients with resected pancreatic cancer. Patients with incomplete documentation were excluded. Patient demographics, pancreatic lesion characteristics, surgical pathology and operative reports, as well as EUS report data were recorded. Comparative analysis of patients who had EUS performed at a single academic medical center (AMC) and referring institutions (OSH) was performed. 203 patients underwent surgical resection for pancreatic cancer between 2013-2019 and had an EUS report available for review. The mean patient age was 65.4±0.64* years, mean BMI 27.3±0.39, and 95 (46.8%) were female. EUS-FNA/B (fine needle aspiration/biopsy) revealed malignancy in 85.7% cases at the AMC and 80.4% at OSH (p=0.35). Significant differences between the AMC and OSH EUS reports were noted in terms of compliance with ASGE quality indicators. Specifically, the total number of ASGE quality indicators (6.6±0.1 vs 5.6±0.2, p= <0.001) included in the report, listing of an ASGE approved indication for EUS (99.3% vs 89.3%, p=0.002), use on an on-site cytopathologist (69.9% vs 51.8%, p= 0.02), TNM classification (56.3% vs 23.2%, p= <0.001) inclusion, and documentation of the presence or absence of an intraprocedural complication (100% vs 83.9%, p= <0.001) were significantly higher in the AMC EUS reports (Table 1). AMC EUS reports were more likely to describe the biliary tree (97.3% vs 67.9%, p= <0.001) though were less likely to describe the pancreatic duct (74.1% vs 89.3%, p=0.02). No other factors were statistically significant (Table 1). In our cohort of patients with resected pancreatic cancer who had previously undergone EUS, the quality of EUS reports from an AMC were superior to OSH EUS reports based on ASGE quality indicators for EUS. However, this did not translate into a statistically significant increase in the diagnostic yield of EUS-FNA/B. Further evaluation with a larger patient population will likely be beneficial.