ANALYSIS OF PERFORMANCE MEASURES IN DEVICE ASSISTED ENTEROSCOPY (DAE)

Aims The European Society of Gastrointestinal Endoscopy (ESGE) small-bowel working group identified a list of performance measures for small-bowel endoscopy with the final goal of quality improvement. The aim of this study is to analyze the performance measures for device assisted enteroscopy (DAE) at a service level.

Methods Cross-sectional analysis of DAE performed between 01/2015-07/2019 in our center. The authors evaluated 10 performance measures (6 key and 4 minor) associated to 6 quality domains. DAE interrupted because of inadequate bowel preparation or gastric stasis, or DAE performed in the setting of endoscopic retrograde cholangiopancreatography (ERCP) were excluded from our analysis.

Results The authors analyzed 128 DAE, 51.6% males, with a mean age of 65.6 ± 15.8 years-old. Key performance measures: appropriate indication for DAE according to ESGE guidelines in 82.8% (106/128); tattooing the point of maximal insertion depth in 60% (18/30, excluding subsequent DAE or DAE in which panenteroscopy was not pretended); diagnostic yield of 76.5% (91/119); tattooing of lesions detected/treated, intended for further treatment (endoscopic resection or surgery) in 85.7% (6/7). No complications were described and the patient comfort was not audited after DAE. Minor performance measures: proper instructions for bowel preparation in 95.1% (97/102 excluding emergency DAE and patients with ongoing bleeding); reporting the depth of insertion in 98.4% (126/128); accurate photodocumentation of pathology/lesions detected in 85.7% (78/91) and successful therapeutic intervention in 87.2% (68/78).

Conclusions The following performance measures were achieved: proper instructions for bowel preparation (≥ 95%), reporting the depth of insertion (≥ 80%), diagnostic yield (≥ 50%), successful therapeutic intervention (≥ 80%) and complication rate (< 5%). Although some standards were not achieved (i.e. indication and accurate photodocumentation ≥ 95%), feedback to the staff involved in the procedure should be given to increase performance indexes and achieve the proposed standards.