Gastroscopy Quality Measures in Real World Practice: Challenges to Implementation
J. Peacock, E. Keating, J. Leyden, C. Lahiff
Gastrointestinal Unit, Mater Misericordiae University Hosptial, Dublin 7 School of Medicine, University College Dublin
Gastroscopy is an important diagnostic procedure. Quality can vary between practitioners. Guidelines promoting a systematic, anatomical assessment based on standardised image capture were published by ESGE in 2016.
To assess a cross-section of gastroscopies performed at the Mater University Hospital and analyse performance against ESGE guidelines.
A retrospective analysis was conducted of gastroscopies completed in a one-week period. Procedural time was recorded by first and last image timestamps captured on our endoscopy reporting system. Two endoscopists assessed images of ten anatomical landmarks. A full, clear image scored 3 while an absent image scored 0. Maximal score was 30.
Seventy-four gastroscopies were analysed over the study period. Median procedure time was 4.0 minutes (range 1-12). Median sedation was within JAG thresholds. No sedation was administered in 15% (n=11). Clear images of D2 and fundus were observed in 84% and 72% respectively. Median number of images recorded was 7 (range 2-10). The most omitted images were the greater curve in retroflexion (74%), incisura (73%) and proximal oesophagus (65%). Median image quality score was 2.3 (range 0-3). Median image quality score was 17 (range 6-29). There was no correlation between procedure time and a) number of images captured (r=0.003, CI -0.33-0.21, p=0.65) or b) image score (R =0.0008, CI -0.09-0.07, p=0.8).
Procedure duration does not appear to impact upon number or quality of images captured. Accurate measurements of procedure times are challenging in real world practice. Further investigation will require a prospective study which should include pathology yields.