Dr. Buckles said that one of the highlights of the review was that researchers were able to confidently say that use of standardized checklists and frequent auditing had value in improving preprocedural and postprocedural quality indicators.
“The authors also concluded that focused educational interventions might improve endoscopists’ abilities to adhere to standardized Barrett’s esophagus examinations,” he added. “Unfortunately, the authors were not able to find much evidence for interventions that would improve intraprocedural EGD quality indicators.”
The authors pointed to a prospective study that evaluated whether an audit intervention helped in 10,000 consecutive EGDs. They found the audits “improved EGD report quality, such as justification for incompleteness or accurate lesion/segment description, regardless of the endoscopist’s experience documenting the report (specialist vs. trainee).” When audits were used in other studies to evaluate endoscopy overall performance (including EGD and colonoscopy) results showed similar improvement in important endpoints, the authors wrote. Additionally, “use of dictation templates has been demonstrated to improve the completeness of endoscopy report.”
A study led by the European Network for the Investigation of Gastrointestinal Mucosal Alterations found inconsistent compliance with EGD biopsy–sampling guidelines in patients with signs of gastric pathology, even in academic centers. The authors of that study recommended dedicated educational programs to raise awareness of which scenarios warrant gastric sampling during EGD.
The authors of the current study also acknowledge that many sound practices that likely improve quality, for instance time-outs or checklists for administering antibiotics during percutaneous feeding tube placement, are unlikely to be formally studied.
“Nevertheless, such practices should be encouraged and monitored,” they wrote.
“This document synthesizes practices and interventions that may allow for a high-quality upper endoscopy,” they concluded. “Furthermore, the scarcity of strong data to support interventions that can improve important quality indicators in upper-GI endoscopy should be seen as an opportunity.”
Several authors disclosed relationships with commercial interests, such as Boston Scientific, Salix, and Janssen. Dr. Buckles reports no relevant financial relationships.