Practice Management

2 - Factors Associated With Over-Utilization of Repeat Upper Endoscopy in Patients With Non-Dysplastic Barrett's Esophagus (NDBE): A Study Using the GI Quality Improvement Consortium (GIQuIC) National Registry

Monday, October 8
8:12 AM - 8:24 AM
Location: Terrace Ballroom (level 400)

Category: Practice Management
Sachin Wani, MD1, J. Lucas Williams, MPH2, Sri Komanduri, MD3, Raman Muthusamy, MD4, Nicholas J. Shaheen, MD, MPH5
1University of Colorado Anschutz Medical Campus, Aurora, CO; 2GI Quality Improvement Consortium, Bethesda, MD; 3Feinberg School of Medicine, Northwestern University, Chicago, IL; 4University of California Los Angeles, Los Angeles, CA; 5University of North Carolina School of Medicine, Chapel Hill, NC

Award: Category Award (Practice Management)

Introduction: Guidelines recommend that patients with NDBE undergo surveillance endoscopy at 3-5 yr intervals (quality indicator). Population-based estimates of adherence and factors associated with adherence to this recommendation are limited. Using a national benchmarking clinical registry, we aimed to identify factors associated with adherence to surveillance endoscopy intervals in NDBE patients.

Methods: We analyzed data from the GIQuIC Registry, a national data repository of endoscopy quality measures. Upper endoscopy data (1/2013-9/2017) include procedure indication, demographics, endoscopy findings, pathology results, and recommendations for future endoscopy. Patients with an indication of BE screening or surveillance, or an endoscopic finding of BE, were included. Adherence to recommended surveillance for NDBE was calculated by assessing the proportion recommended to undergo an EGD between 3-5 years. Univariate followed by multivariate logistic regression analyses were conducted for each independent variable to assess the association with adherence.

Results: A total of 786,712 EGDs were assessed, and 58,709 (7.5%) EGDs in 53,541 patients met inclusion criteria [mean age 61.3 yrs (SD 12.6), 60.4% male, 90.2% Caucasian]. These represented 263 practices nationwide and 1457 unique providers. The majority of cases were performed by GIs (92.3%) with propofol (78.7%). The distribution of cases based on US census region was: Northeast (27.6%), South (30.7%), Midwest  (18.8%) and West (22.8%). Mean BE length was 2.3 cm (SD 2.31) and biopsies were obtained in 54,943 (93.6%) procedures. A total of 29,978 (55.8%) procedures resulted in a recorded pathology-confirmed diagnosis of BE [NDBE – 25,945 (86.5%)]. Among procedures with NDBE, 29.9% were non-compliant with the 3-year threshold; most (26.9%) were recommended surveillance at 1-2 year intervals. Majority of those compliant were recommended 3-year surveillance endoscopies. Patient factors such as age, black race, increasing BE length and type of sedation were associated with non-compliance to surveillance endoscopy guidelines (Table).

Discussion: This population-based analysis demonstrates that in procedures resulting in NDBE diagnosis, 30% are recommended to undergo surveillance EGDs too soon. We identified several factors associated with inappropriate surveillance including age, black race, increasing BE length and type of sedation. Future efforts should focus on improved dissemination of guidelines and quality indicators in BE management.

Multivariate logistic regression model for compliance to appropriate endoscopic surveillance intervals in patients with non-dysplastic Barrett's esopahgus

Disclosures:
Sachin Wani: Boston Scientific – Consultant. Medtronic – Consultant.
J. Lucas Williams indicated no relevant financial relationships.
Sri Komanduri: Boston Scientific – Consultant. Medtronic – Consultant.
Raman Muthusamy: Boston Scientific – Consultant. Medtronic – Consultant.
Nicholas Shaheen: Boston Scientific – Consultant. Boston Scientific – Grant/Research Support. C2 Therapeutics – Grant/Research Support. CDx – Grant/Research Support. CSA – Grant/Research Support. Interspace Diagnostics – Grant/Research Support. Medtronic – Grant/Research Support. Shire – Consultant.

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2 - Factors Associated With Over-Utilization of Repeat Upper Endoscopy in Patients With Non-Dysplastic Barrett's Esophagus (NDBE): A Study Using the GI Quality Improvement Consortium (GIQuIC) National Registry



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