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Endoscopist biopsy rate as a quality indicator for outpatient gastroscopy: a multicenter cohort study with validation.
Gastrointestinal Endoscopy ( IF 6.7 ) Pub Date : 2019-01-17 , DOI: 10.1016/j.gie.2019.01.008 Wladyslaw Januszewicz 1 , Paulina Wieszczy 2 , Andrzej Bialek 3 , Katarzyna Karpinska 4 , Jakub Szlak 5 , Jakub Szymonik 5 , Maciej Rupinski 6 , Andrzej Mroz 7 , Jaroslaw Regula 6 , Michal F Kaminski 8
Gastrointestinal Endoscopy ( IF 6.7 ) Pub Date : 2019-01-17 , DOI: 10.1016/j.gie.2019.01.008 Wladyslaw Januszewicz 1 , Paulina Wieszczy 2 , Andrzej Bialek 3 , Katarzyna Karpinska 4 , Jakub Szlak 5 , Jakub Szymonik 5 , Maciej Rupinski 6 , Andrzej Mroz 7 , Jaroslaw Regula 6 , Michal F Kaminski 8
Affiliation
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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.
中文翻译：
内镜活检率作为门诊胃镜检查的质量指标：一项多中心队列研究，并经过验证。
背景与目的胃癌前病变（GPC）的诊断依赖于内镜检查和粘膜取样。我们假设内镜活检率（EBR）可能构成EGD的质量指标，并且我们已经分析了其与GPC检测和胃癌漏诊率（GCs）的关联。方法我们分析了来自2个高门诊部门的EGD数据库。EBR值，定义为在A单元（派生队列）中每个内镜医师计算的活检≥1次的EGD在所有检查中所占的比例，并将四分位数分为四组。计算每组的GPC检出率，并使用多元聚类Logistic回归模型进行比较。B单元数据库用于验证。所有患者均在癌症登记处随访，因为他们在EGD后1个月至3年内被诊断出漏诊的GC，结果均为阴性。结果A单元内的16名内镜医师进行了17,490次EGD，其中分析了15,340次（87.7％）。EBR四分位值分别为22.4％至36.7％（低EBR），36.8％至43.7％（中度），43.8％至51.6％（高）以及51.7％和65.8％（非常高）；中值43.8％。检测GPC的中，高和非常EBR组的几率分别为1.6（95％置信区间[CI]，1.3-1.9），2.0（95％CI，1.7-2.4）和2.5（95％）与低EBR组相比，CI（2.1-2.9）（P <.001）。在验证队列中以相同的阈值确认了这种关联。与EBR较低的组相比，EBR较高（≥43.8％）的内镜医师的癌症漏诊风险较低（优势比为0.44； CI为95％，0.20-1.00；P = .049）。结论内镜医师之间的EBR参数变化很大，并且与GPC检测的效率和GC漏诊率有关。
更新日期：2019-01-17
中文翻译：
内镜活检率作为门诊胃镜检查的质量指标：一项多中心队列研究，并经过验证。
背景与目的胃癌前病变（GPC）的诊断依赖于内镜检查和粘膜取样。我们假设内镜活检率（EBR）可能构成EGD的质量指标，并且我们已经分析了其与GPC检测和胃癌漏诊率（GCs）的关联。方法我们分析了来自2个高门诊部门的EGD数据库。EBR值，定义为在A单元（派生队列）中每个内镜医师计算的活检≥1次的EGD在所有检查中所占的比例，并将四分位数分为四组。计算每组的GPC检出率，并使用多元聚类Logistic回归模型进行比较。B单元数据库用于验证。所有患者均在癌症登记处随访，因为他们在EGD后1个月至3年内被诊断出漏诊的GC，结果均为阴性。结果A单元内的16名内镜医师进行了17,490次EGD，其中分析了15,340次（87.7％）。EBR四分位值分别为22.4％至36.7％（低EBR），36.8％至43.7％（中度），43.8％至51.6％（高）以及51.7％和65.8％（非常高）；中值43.8％。检测GPC的中，高和非常EBR组的几率分别为1.6（95％置信区间[CI]，1.3-1.9），2.0（95％CI，1.7-2.4）和2.5（95％）与低EBR组相比，CI（2.1-2.9）（P <.001）。在验证队列中以相同的阈值确认了这种关联。与EBR较低的组相比，EBR较高（≥43.8％）的内镜医师的癌症漏诊风险较低（优势比为0.44； CI为95％，0.20-1.00；P = .049）。结论内镜医师之间的EBR参数变化很大，并且与GPC检测的效率和GC漏诊率有关。
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