Adherence to European Society of Gastrointestinal Endoscopy Quality Performance Measures for Upper and Lower Gastrointestinal Endoscopy: A Nationwide Survey From the Italian Society of Digestive Endoscopy

Rocco Maurizio Zagari; Leonardo Frazzoni; Lorenzo Fuccio; Helga Bertani; Stefano Francesco Crinò; Andrea Magarotto; Elton Dajti; Andrea Tringali; Paola Da Massa Carrara; Gianpaolo Cengia; Enrico Ciliberto; Rita Conigliaro; Bastianello Germanà; Antonietta Lamazza; Antonio Pisani; Giancarlo Spinzi; Maurizio Capelli; Franco Bazzoli; Luigi Pasquale

doi:10.3389/fmed.2022.868449

Adherence to European Society of Gastrointestinal Endoscopy Quality Performance Measures for Upper and Lower Gastrointestinal Endoscopy: A Nationwide Survey From the Italian Society of Digestive Endoscopy

Front Med (Lausanne). 2022 Apr 6:9:868449. doi: 10.3389/fmed.2022.868449. eCollection 2022.

Authors

Rocco Maurizio Zagari^{1

2}, Leonardo Frazzoni¹, Lorenzo Fuccio^{1

2}, Helga Bertani³, Stefano Francesco Crinò⁴, Andrea Magarotto⁵, Elton Dajti^{1

2}, Andrea Tringali⁶, Paola Da Massa Carrara⁷, Gianpaolo Cengia⁸, Enrico Ciliberto⁹, Rita Conigliaro¹⁰, Bastianello Germanà¹¹, Antonietta Lamazza¹², Antonio Pisani¹³, Giancarlo Spinzi¹⁴, Maurizio Capelli¹⁵, Franco Bazzoli^{1

2}, Luigi Pasquale¹⁶

Affiliations

¹ Gastroenterology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
² Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
³ Gastroenterology and Endoscopy Unit, Azienda Ospedaliera-Universitaria Policlinico di Modena, Modena, Italy.
⁴ Gastroenterology and Digestive Endoscopy Unit, Pancreas Institute, University of Verona, Verona, Italy.
⁵ Diagnostic and Therapeutic Endoscopy Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
⁶ Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
⁷ Digestive Endoscopy Unit, S. Luca Hospital, Lucca, Italy.
⁸ Digestive Endoscopy Unit, Manerbio Hospital, Manerbio, Italy.
⁹ Gastroenterology and Digestive Endoscopy Unit, S. Giovanni di Dio Hospital, Crotone, Italy.
¹⁰ Gastroenterology and Digestive Endoscopy Unit, Baggiovara University Hospital, Baggiovara, Italy.
¹¹ Gastroenterology and Digestive Endoscopy Unit, S. Martino Hospital, Belluno, Italy.
¹² Department of Surgery "Pietro Valdoni", University La Sapienza, Rome, Italy.
¹³ Gastroenterology and Digestive Endoscopy Unit, National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, Bari, Italy.
¹⁴ Gastroenterology and Endoscopy Department, Valduce Hospital, Como, Italy.
¹⁵ Kiwa Cermet Certification Body, Statistical Department, Bologna, Italy.
¹⁶ UOC Gastroenterologia ed Endoscopia Digestiva, Ospedale Frangipane, Avellino, Italy.

Abstract

Background: The quality of gastrointestinal (GI) endoscopy has been recently identified as a major priority being associated with many outcomes and patient's experience.

Objective: To assess adherence of endoscopists to the European Society of Gastrointestinal Endoscopy (ESGE) quality performance measures for upper and lower GI endoscopy in Italy.

Methods: All endoscopist members of the Italian Society of Digestive Endoscopy (SIED) were invited from October 2018 to December 2018 to participate to a self-administered questionnaire-based survey. The questionnaire included questions on demographics and professional characteristics, and the recent ESGE quality performance measures for upper and lower GI endoscopy.

Results: A total of 392 endoscopists participated in the study. Only a minority (18.2%) of participants recorded the duration of esophagogastroduodenoscopy (EGD) and 51% provided accurate photo documentation in the minimum standard of 90% of cases. Almost all endoscopists correctly used Prague and Los Angeles classifications (87.8% and 98.2%, respectively), as well as Seattle and Management of precancerous conditions and lesions in the stomach (MAPS) biopsy protocols (86.5% and 91.4%, respectively). However, only 52.8% of participants monitored complications after therapeutic EGD, and 40.8% recorded patients with a diagnosis of Barrett's esophagus (BE). With regard to colonoscopy, almost all endoscopists (93.9%) used the Boston Bowel Preparation Scale for measuring bowel preparation quality and reported a cecal intubation rate ≥90%. However, about a quarter (26.2%) of participants reported an adenoma detection rate of <25%, only 52.8% applied an appropriate polypectomy technique, 48% monitored complications after the procedure, and 12.4% measured patient's experience.

Conclusion: The adherence of endoscopists to ESGE performance measures for GI endoscopy is sub-optimal in Italy. There is a need to disseminate and implement performance measures and endorse educational and scientific interventions on the quality of endoscopy.

Keywords: ESGE; endoscopy; guidelines; performance measure; quality.