Background and Aims
The diagnosis of gastric premalignant conditions (GPCs) relies on endoscopy with mucosal
sampling. We hypothesized that the endoscopist biopsy rate (EBR) might constitute
a quality indicator for EGD, and we have analyzed its association with GPC detection
and the rate of missed gastric cancers (GCs).
Methods
We analyzed EGD databases from 2 high-volume outpatient units. EBR values, defined
as the proportion of EGDs with ≥1 biopsy to all examinations were calculated for each
endoscopist in Unit A (derivation cohort) and divided by the quartile values into
4 groups. Detection of GPC was calculated for each group and compared using multivariate
clustered logistic regression models. Unit B database was used for validation. All
patients were followed in the Cancer Registry for missed GCs diagnosed between 1 month
and 3 years after EGDs with negative results.
Results
Sixteen endoscopists in Unit A performed 17,490 EGDs of which 15,340 (87.7%) were
analyzed. EBR quartile values were 22.4% to 36.7% (low EBR), 36.8% to 43.7% (moderate),
43.8% to 51.6% (high), and 51.7% and 65.8% (very-high); median value 43.8%. The odds
ratios for the moderate, high, and very-high EBR groups of detecting GPC were 1.6
(95% confidence interval [CI], 1.3-1.9), 2.0 (95% CI, 1.7-2.4), and 2.5 (95% CI, 2.1-2.9),
respectively, compared with the low EBR group (P < .001). This association was confirmed with the same thresholds in the validation
cohort. Endoscopists with higher EBR (≥43.8%) had a lower risk of missed cancer compared
with those in the lower EBR group (odds ratio, 0.44; 95% CI, 0.20-1.00; P = .049).
Conclusions
The EBR parameter is highly variable among endoscopists and is associated with efficacy
in GPC detection and the rate of missed GCs.
Graphical abstract
Graphical Abstract
Abbreviations:
BE (Barrett’s esophagus), CI (confidence interval), DA (duodenal adenoma), EBR (endoscopist biopsy rate), GC (gastric cancer), GD (gastric dysplasia), GPC (gastric precancerous condition), OR (odds ratio), SIN (squamous intraepithelial neoplasm), UGI (upper gastrointestinal)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: January 16, 2019
Accepted:
January 2,
2019
Received:
September 10,
2018
Footnotes
If you would like to chat with an author of this article, you may contact Dr Januszewicz at [email protected]
DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.
Identification
Copyright
© 2019 by the American Society for Gastrointestinal Endoscopy
ScienceDirect
Access this article on ScienceDirectLinked Article
- Endoscopic biopsies in diagnostic outpatient gastroscopy: more is not always better!Gastrointestinal EndoscopyVol. 90Issue 3
- PreviewWe have read with great interest the study by Januszewicz et al1 describing the concept of endoscopist biopsy rate (EBR) as a potential quality indicator for routine diagnostic outpatient EGD. The authors found a significant variability in EBR among 26 endoscopists and an association between higher EBR, a higher detection of gastric precancerous conditions, and a lower risk of missed gastric cancers.1
- Full-Text
- Preview
- Routine gastric biopsies: Should we be doing more?Gastrointestinal EndoscopyVol. 89Issue 6
- PreviewAlthough extensive research has been focused on the role of quality metrics in the performance of colonoscopy, relatively less attention has been given to the performance of upper endoscopy. The American Society for Gastrointestinal Endoscopy/American College of Gastroenterology Task Force on Quality in Endoscopy has published quality indicators for upper endoscopy; however, most measures were process related, and the lack of recognized outcome measures was described.1 There are currently no metrics for the detection of gastric premalignant conditions (GPCs) or gastric cancers (GCs).
- Full-Text
- Preview
