RECENT UPPER GASTROINTESTINAL ENDOSCOPY QUALITY MEASURES SEEM TO BE USEFUL BUT NEED FURTHER VALIDATION. A MULTICENTER OBSERVATIONAL STUDY

Aims The proper visualization and image interpretation are the key factors of good Esophagogastrodudenoscopy (EGD) quality. Nevertheless, the proper quality indicators were not yet validated for EGD. Recently two metrics were proposed: composite detection rate (CDR - the sum of gastric inlet patch, gastric polyps and duodenal bulb deformations detection rates) and endoscopist biopsy rate (EBR) that in university endoscopy units corresponds with higher gastric premalignant lesions detection and lower gastric cancers miss rate. The aim of the study was to verify these metrics among different endoscopy units settings.

Methods It was a prospective, observational, multicenter study. 2984 individuals who underwent diagnostic EGD were enrolled in 3 centers: local hospital (1), private out-patient endoscopy unit (2) and university hospital (3). Operators were informed that their performance would be measured. EBR and CDR were collected. The study was performed in accordance to declaration of Helsinki in agreement with bioethics committee.

Results The differences in EBR were significant among centers (76.97% vs 49.56% vs 66.6%; 1,2 and 3 respectively). CDR also varied significantly (10.68%±0.32 vs 22.29%±0.44 vs 38.21±55.91; 1,2 and 3 respectively). Examinations with at least one biopsy had significantly higher CDR (8.22% vs 32.62% p< 0.000). ROC analysis revealed that EBR seemed not to be a good quality indicator in relation to CDR (AUC 0.612±0.0; 95%CI 0.591 - 0.632).

Conclusions EBR is not fully validated tool and it seems that in some settings it may not correspond with operators perception measured by CDR. EBR as validated in university endoscopy units, may not be useful for local hospital units. CDR could reflect better EGD quality in general evaluation, however this tool needs further validation.