Improving Quality and Safety in the Endoscopy Unit (Virtual) | October 2024-ASGE ACG QI for EET in BE

ASGE ACG QI for EET in BE

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The development of quality indicators for endoscopic eradication therapies (EET) in Barrett’s esophagus (BE) is critical to improving patient outcomes and ensuring high-quality care. Barrett’s esophagus is a precursor to esophageal adenocarcinoma, a cancer with a low survival rate. EET, including endoscopic mucosal resection and radiofrequency ablation, is used to manage BE-related dysplasia and neoplasia, aiming to prevent progression to cancer.<br /><br />A consortium of experts developed quality indicators for EET using the RAND/University of California, Los Angeles Appropriateness Methodology. This approach evaluates the appropriateness of clinical interventions by comparing expected benefits to potential risks. An international panel consisting of gastroenterologists, pathologists, and methodologists was assembled to identify and rate potential quality indicators relevant to pre-procedure, intra-procedure, and post-procedure phases of EET.<br /><br />Quality indicators developed for the pre-procedure phase stress the confirmation of dysplasia diagnosis by GI pathologists and the availability of necessary equipment like high-definition white light endoscopy. Intra-procedure indicators emphasize clear documentation of the BE segment's characteristics, like using the Prague criteria, ensuring complete mucosal inspection with advanced imaging, and performing endoscopic resection for visible lesions. Post-procedure indicators include recommending anti-reflux therapy and regular surveillance to monitor adverse events and recurrence.<br /><br />The panel determined performance benchmarks for these practices to encourage standardization and improve care. They recommended that these quality indicators be incorporated into training curricula and used to develop guidelines that ensure value-based healthcare, aligning clinical practice with current standards emphasizing quality and patient outcomes. Although the study provides a framework for improved management of BE-related neoplasia, it acknowledges the need for ongoing evaluation and adjustment of these quality indicators to reflect advancements in the field and emerging clinical data.

Keywords

Barrett's esophagus

endoscopic eradication therapies

quality indicators

esophageal adenocarcinoma

endoscopic mucosal resection

radiofrequency ablation

RAND/UCLA Appropriateness Methodology

Prague criteria

anti-reflux therapy

value-based healthcare