P1340 - Meta-Analysis of the Endoscopy Core Quality Indicators: Photodocumentation, Biopsy Number, and Procedure Duration

Eleazar E.. Montalvan-Sanchez, MD¹, Dalton A. Norwood, MD², Alicia A. Gutierrez Zamorano, ³, Renato Beas, MD⁴, Mirian Ramirez-Rojas, MLIS⁵, Keila Carrera, MD⁶, Leandro Sierra, MD⁷, Shajan Peter, MD⁸, Sergio A. Sánchez-Luna, MD⁸, Douglas Morgan, MD, MPH^9
1Indiana University School of Medicine, Indianapolis, IN; ²UAB Minority Health and Health Equity Research Center, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL; ³Universidad Anahuac, Mexico, Estado de México, Mexico; ⁴Indiana University, Indianapolis, IN; ⁵Ruth Lilly Medical Library, Indiana University School of Medicine, Indianapolis, IN; ⁶Hospital Manuel Nuñez Tovar, Unidad de Gastroenterologia., Monagas, Monagas, Venezuela; ⁷Beth Israel Deaconess Medical Center, Boston, MA; ⁸Basil I. Hirschowitz Endoscopic Center of Excellence, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL; ⁹University of Alabama at Birmingham, Birmingham, AL

Introduction: Quality indicators (QI) in upper endoscopy provide procedure benchmarks to assess performance. Endoscopy QI standards have focused on conditions (e.g., Barrett’s, PUD bleeding), but general measures have been lacking. We conducted a meta-analysis of general endoscopy QI: photodocumentation, biopsy number and procedure duration.

Methods: We performed a systematic review of the literature from January 2003 to May 2023 to identify studies that investigated Upper endoscopies quality indicators (biopsy number, photodocumentation and endoscopy duration) by searching the MEDLINE, EMBASE, Cochrane, Scopus and Web of Science databases.

Results: The literature search yielded 3962 studies, of which 37 were identified for full-text review, with 22 studies filling the criteria for final analysis. (Table). 7 studies were relevant to photodocumentation. 4/7 studies assessed the complete examination number per anatomical landmark with a pooled completion number of 32.6% (95%CI: 1.6-77.7). The second duodenum, GEJ and cardia were the sites with higher completion rates (82.4%, 64.2% and 63.9% respectively). Pharynx, incisura, and duodenum bulb had the lowest completion numbers. Of the 5 studies that assessed the number of endoscopy biopsies (NEB), 2 studies examined the impact of NEB on gastric premalignant conditions (GPMC): high and very high NEB yielded in higher odds of finding GPMCs (OR: 1.6 and 5.6 respectively). For neoplasia detection, there was no significant association with NEB. Ten studies addressed the duration of endoscopy. The pooled mean time of endoscopy was 3.7 minutes (95%CI: 2.4-5.2). Four studies compared endoscopy duration with the yield of lesion detection: 5-7 min vs < 5min OR 1.64 (95%CI: 1.4-1.98)]. One study compared >7min vs < 5min with an OR of 1.9 (95%CI: 0.98-3.6).

Discussion: In conclusion, our meta-analysis examining quality indicators in upper endoscopy revealed a limited and heterogeneous literature. Photodocumentation demonstrated a low completion rate in the stomach, and with higher numbers in the second duodenum, GEJ, and cardia. A greater number of biopsies were associated with increased GPMC detection. Overall endoscopy duration was only 3.7. A procedure duration greater than 5-7 minutes had higher odds of lesion detection. These findings emphasize the significance of optimizing quality indicators to improve the diagnostic yield and overall quality of upper endoscopy.





Disclosures:


Eleazar E.. Montalvan-Sanchez, MD¹, Dalton A. Norwood, MD², Alicia A. Gutierrez Zamorano, ³, Renato Beas, MD⁴, Mirian Ramirez-Rojas, MLIS⁵, Keila Carrera, MD⁶, Leandro Sierra, MD⁷, Shajan Peter, MD⁸, Sergio A. Sánchez-Luna, MD⁸, Douglas Morgan, MD, MPH⁹. P1340 - Meta-Analysis of the Endoscopy Core Quality Indicators: Photodocumentation, Biopsy Number, and Procedure Duration, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.