Do We Have Quality Indicators for EGD?
Welcome to this week’s clinical digest from EndoCollab. While we have well-established quality indicators for colonoscopy, the benchmarks for EGD remain less defined. A compelling study in GIE suggests a new potential quality metric: the gastric biopsy rate. The data indicates a powerful correlation—endoscopists who performed more biopsies were significantly less likely to miss gastric cancers. Free subscribers receive these key takeaways, while paid members unlock our full archive, device-demo videos, comment access, video courses, and the founding members' WhatsApp group. Ready for the deeper dive? Upgrade and join us.
Do we have quality indicators for EGD? Not many. However, various studies have shown that endoscopist who takes their time to perform an EGD detect more cancers and preneoplastic lesions.
Nonetheless, we still don't know what "taking our time" is. Based on the available data we recommend not to perform an EGD in less than 5 minutes, unless it is an emergency and focused diagnosis or therapy is mandated.
In this study from Poland, the authors found that endoscopists that biopsy more also found more stomach cancers. Or the other way around, endoscopist who perfomed less biopsies were more likely to miss cancers. As the study was retrospective it has its inherent deficits. However, the close follow-up of more than 29,000 patients and the correlation of endoscopic and histologic findings with the data of the national cancer registry are major strengths.
I strongly believe that endoscopists that takes their time to perform endoscopy, carefully inspecting the esophagus, stomach and duodenum will have higher chances of detecting abnromal lesions, than "quick" endoscopists.
Jorunal: GIE June 2019
This study adds an interesting layer to the conversation around EGD quality indicators, moving beyond just withdrawal time. What is your threshold for taking screening or surveillance biopsies in a visually normal-appearing stomach? How do you balance biopsy rate with efficiency and pathology costs in your practice? We're curious to hear about your protocols and your perspective on what truly constitutes a high-quality upper endoscopy for gastric cancer detection.
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