THE TIME OF ESOPHAGOGASTRODUDENOSCOPY IN RELATION TO EXAMINATION QUALITY MEASURES

Aims Esophagogastrodudenoscopy (EGD) is widely available endoscopy procedure that is not free from false-negative results, reaching up to 9.4% of cases in gastric cancer. Recently, two quality indicators of EGD were proposed: endoscopist biopsy rate (EBR) and composite detection rate (CDR - the sum of gastric inlet patches, gastric polyps and duodenal bulb deformations detection rates). It was also suggested that duration of EGD should not be shorter than 5 or 7 minutes or withdrawal time not less than 3 minutes. The aim of the study is to determine if proposed quality indicators reflect duration of the procedure.

Methods 987 patients who underwent diagnostic EGD have been enrolled in the study (01.2017 - 01.2018). EGDs were performed by six experienced endoscopists and the examination time was measured by nursing staff using the stopwatch. The EBR and CDR were recorded. The study has been performed in accordance to declaration of Helsinki in agreement with bioethics committee. Informed consent was obtained from all of the participants.

Results Mean examination time with and without biopsy differed significantly among operators (range 207 ±58.1 - 358 ±58.9 sec.; p < 0.000; and 191 ±54.6 - 315 ±22.9 sec. p < 0.000 respectively). Examination time correlated with CDR (R=0.24; p< 0.001). Mean EGD time with at least ‘1’ of CDR differed significantly among operators (226 ±59.6 sec. - 378 ±80.8 sec.; p< 0.0001). Mean EGD time during which at least one biopsy was taken ranged between operators from 248 ±57.2 sec. to 392 ±83.5 sec.; p< 0.0001.

Conclusions The examination time of EGD was moderately associated with CDR, however, it was significantly different between experienced endoscopists. It seems that it is more important to optimize and validate EBR and CDR as quality metrics of EGD instead of defining minimal limits for examination length.