Original article Clinical endoscopy| Volume 94, ISSUE 1, P68-74.e3, July 2021

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Quality metrics in the performance of EUS: a population-based observational cohort of the United States

Published:January 18, 2021DOI:

      Background and Aims

      There are few data on the quality of EUS in the community setting. We characterized EUS performance at the individual facility level in 3 large American states, using need for repeat biopsy (NRB) as a metric for procedural failure, and the rate of unplanned hospital encounters (UHEs) as a metric for adverse events.


      We collected data on 76,614 EUS procedures performed at 166 facilities in California, Florida, and New York (2009-2014). The endpoints for the study were 7-day rate of UHEs after EUS, and 30-day rate of NRB after EUS with fine-needle aspiration. Facility-level factors analyzed included annual procedure volume, urban/rural location, and free-standing status (facilities not attached to a larger hospital). Predictors for UHE and NRB were analyzed in both multivariable regression and nonparametric local regression.


      Facility volume did not predict risk for UHEs. However, high facility volume protected against NRB (P trend <.001) even after adjustment for other facility-level factors. When regressing facility volume against risk for NRB in local regression, a join point (inflection point) was identified at 97 procedures per annum. Once facilities reached this threshold volume, there appeared little additional protective effect of higher volume. Rural facility location (odds ratio, 1.81; 95% confidence interval, 1.36-2.40) and free-standing status (odds ratio, 1.57; 95% confidence interval, 1.16-2.13) were also associated with NRB.


      Facility volume does not predict risk for adverse events after EUS. However, high facility volume is associated with decreased rates of technical failure (as assessed by NRB). These data provide one of the first descriptions of EUS practice in community settings and highlight opportunities to improve endoscopic quality nationally.


      ASC (ambulatory surgery center), ASGE (American Society for Gastrointestinal Endoscopy), CI (confidence interval), CPT (Current Procedural Terminology), ICD-9-CM (International Classification of Disease 9th Revision Clinical Modification), LOESS (local regression), NRB (need for repeat biopsy), OR (odds ratio), UHE (unplanned hospital encounter)
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      Linked Article

      • Improving quality in EUS: a call for a national benchmarking registry
        Gastrointestinal EndoscopyVol. 94Issue 1
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          EUS and EUS-guided tissue acquisition (EUS-TA) have become central techniques in the assessment of GI and non-GI malignancies and numerous nonmalignant processes.1,2 We continue to observe an exponential increase in EUS procedure volumes in the United States coupled with an increase in the number of endoscopists trained in EUS and improvement in the devices required for EUS-TA.3 In keeping with the unprecedented increased focus on quantifying and improving the quality of healthcare and the trend in the United States to move toward a high-value care platform from a system centered on high-volume care, quality indicators (QIs) for EUS have been established.
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