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  • Measure Summary
  • NQMC:010968
  • Sep 2016

Upper gastrointestinal (UGI) endoscopy: percentage of patients with a confirmed diagnosis of Barrett's esophagus who are entered into a registry to monitor the incidence of dysplasia.

Bisschops R, Areia M, Coron E, Dobru D, Kaskas B, Kuvaev R, Pech O, Ragunath K, Weusten B, Familiari P, Domagk D, Valori R, Kaminski MF, Spada C, Bretthauer M, Bennett C, Senore C, Dinis-Ribeiro M, Rutter MD. Performance measures for upper gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. Endoscopy. 2016 Sep;48(9):843-64. PubMed External Web Site Policy

View the original measure documentation External Web Site Policy

This is the current release of the measure.

Primary Measure Domain

Clinical Quality Measures: Process

Secondary Measure Domain

Does not apply to this measure

Description

This measure is used to assess the percentage of patients with a confirmed diagnosis of Barrett's esophagus who are entered into a registry to monitor the incidence of dysplasia.

Rationale

The Importance of Quality

Tens of millions of people undergo endoscopic procedures every year in Europe. Endoscopy is the pivotal investigation in the diagnosis of gastrointestinal pathology and a powerful tool in its management. High quality endoscopy delivers better health outcomes and a better patient experience (Rutter & Rees, 2014), yet there is clinically significant variation in the quality of endoscopy currently delivered in endoscopy units (Rajasekhar et al., 2012; Baillie & Testoni, 2007; Cotton, 2011; Williams et al., "Risk factors," 2007; Williams et al., "Are we meeting," 2007).

An example of this is post-colonoscopy colorectal cancer (PCCRC). It is known that the majority of PCCRCs arise from missed lesions (premalignant polyps or cancers) or incomplete polypectomy (Pabby et al., 2005; Robertson et al., 2014). Back-to-back colonoscopy studies show that 22% of all adenomas are missed (van Rijn et al., 2006; Van Gelder et al., 2004; Pickhardt et al., 2003; Rockey et al., 2005; Miller & Lehman, 1978; Pickhardt et al., 2004), and that there is a three- to sixfold variation in adenoma detection rates between endoscopists (Barclay et al., 2006; Chen & Rex, 2007).

Even when polyps are found, removal may be incomplete: the Complete Adenoma REsection (CARE) study concluded that 10% of nonpedunculated polyps of 5 to 20 mm and 23% of nonpedunculated polyps of 15 to 20 mm were incompletely resected (Pohl et al., 2013). Furthermore, low cecal intubation rates and poor bowel preparation regimens may explain the relative failure of colonoscopy to protect against proximal colorectal cancer that was found in many studies (Singh et al., "The reduction," 2010; Baxter et al., 2009; Brenner et al., 2010; Baxter et al., 2012; Lakoff et al., 2008; Singh et al., "Rate and predictors," 2010; Brenner et al., 2006; Brenner et al., 2011). This results in clinically important differences in quality of care and patient outcomes: a recent study in the United Kingdom (UK) demonstrated a more than fourfold variation in PCCRC rates between hospitals (Valori et al., 2014).

In the upper gastrointestinal (UGI) tract, gastric cancers and precursor lesions are frequently missed: in one series, 7.2% of patients with gastric cancer did not have the lesion detected at endoscopy performed in the preceding 1 year. Of these cases, almost three quarters were felt to be due to endoscopist error (Yalamarthi et al., 2004). Equally, in endoscopic retrograde cholangiopancreatography (ERCP), which is one of the most complex and highest risk procedures performed regularly in endoscopy practice, there is evidence of wide variation in both completion and complication rates (Raftopoulos et al., 2010; Cohen et al., 2006; Faigel et al., 2006; Park & Cohen, 2012; Gavin et al., 2013; Enochsson et al., 2010; Baron et al., 2006; Cotton et al., 2009).

Rationale

Better follow-up of Barrett's patients helps to identify risk factors, and helps with an accurate incidence of neoplasia and adherence to surveillance guidelines.

Evidence for Rationale

Baillie J, Testoni PA. Are we meeting the standards set for ERCP?. Gut. 2007 Jun;56(6):744-6. PubMed External Web Site Policy

Barclay RL, Vicari JJ, Doughty AS, Johanson JF, Greenlaw RL. Colonoscopic withdrawal times and adenoma detection during screening colonoscopy. N Engl J Med. 2006 Dec 14;355(24):2533-41. PubMed External Web Site Policy

Baron TH, Petersen BT, Mergener K, Chak A, Cohen J, Deal SE, Hoffinan B, Jacobson BC, Petrini JL, Safdi MA, Faigel DO, Pike IM, ASGE/ACG Taskforce on Quality in Endoscopy. Quality indicators for endoscopic retrograde cholangiopancreatography. Am J Gastroenterol. 2006 Apr;101(4):892-7. PubMed External Web Site Policy

Baxter NN, Goldwasser MA, Paszat LF, Saskin R, Urbach DR, Rabeneck L. Association of colonoscopy and death from colorectal cancer. Ann Intern Med. 2009 Jan 6;150(1):1-8. PubMed External Web Site Policy

Baxter NN, Warren JL, Barrett MJ, Stukel TA, Doria-Rose VP. Association between colonoscopy and colorectal cancer mortality in a US cohort according to site of cancer and colonoscopist specialty. J Clin Oncol. 2012 Jul 20;30(21):2664-9. PubMed External Web Site Policy

Bisschops R, Areia M, Coron E, Dobru D, Kaskas B, Kuvaev R, Pech O, Ragunath K, Weusten B, Familiari P, Domagk D, Valori R, Kaminski MF, Spada C, Bretthauer M, Bennett C, Senore C, Dinis-Ribeiro M, Rutter MD. Performance measures for upper gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. Endoscopy. 2016 Sep;48(9):843-64. PubMed External Web Site Policy

Brenner H, Chang-Claude J, Seiler CM, Rickert A, Hoffmeister M. Protection from colorectal cancer after colonoscopy: a population-based, case-control study. Ann Intern Med. 2011 Jan 4;154(1):22-30. PubMed External Web Site Policy

Brenner H, Chang-Claude J, Seiler CM, Stürmer T, Hoffmeister M. Does a negative screening colonoscopy ever need to be repeated?. Gut. 2006 Aug;55(8):1145-50. PubMed External Web Site Policy

Brenner H, Hoffmeister M, Arndt V, Stegmaier C, Altenhofen L, Haug U. Protection from right- and left-sided colorectal neoplasms after colonoscopy: population-based study. J Natl Cancer Inst. 2010 Jan 20;102(2):89-95. PubMed External Web Site Policy

Chen SC, Rex DK. Endoscopist can be more powerful than age and male gender in predicting adenoma detection at colonoscopy. Am J Gastroenterol. 2007 Apr;102(4):856-61. PubMed External Web Site Policy

Cohen J, Safdi MA, Deal SE, Baron TH, Chak A, Hoffman B, Jacobson BC, Mergener K, Petersen BT, Petrini JL, Rex DK, Faigel DO, Pike IM, ASGE/ACG Taskforce on Quality in Endoscopy. Quality indicators for esophagogastroduodenoscopy. Am J Gastroenterol. 2006 Apr;101(4):886-91. PubMed External Web Site Policy

Cotton PB, Garrow DA, Gallagher J, Romagnuolo J. Risk factors for complications after ERCP: a multivariate analysis of 11,497 procedures over 12 years. Gastrointest Endosc. 2009 Jul;70(1):80-8. PubMed External Web Site Policy

Cotton PB. Are low-volume ERCPists a problem in the United States? A plea to examine and improve ERCP practice-NOW. Gastroenterol Endosc. 2011 Jul;74(1):161-6. PubMed External Web Site Policy

Enochsson L, Swahn F, Arnelo U, Nilsson M, Löhr M, Persson G. Nationwide, population-based data from 11,074 ERCP procedures from the Swedish Registry for Gallstone Surgery and ERCP. Gastroenterol Endosc. 2010 Dec;72(6):1175-84. PubMed External Web Site Policy

Faigel DO, Pike IM, Baron TH, Chak A, Cohen J, Deal SE, Hoffman B, Jacobson BC, Mergener K, Petersen BT, Petrini JL, Rex DK, Safdi MA, ASGE/ACG Taskforce on Quality in Endoscopy. Quality indicators for gastrointestinal endoscopic procedures: an introduction. Am J Gastroenterol. 2006 Apr;101(4):866-72. PubMed External Web Site Policy

Gavin DR, Valori RM, Anderson JT, Donnelly MT, Williams JG, Swarbrick ET. The national colonoscopy audit: a nationwide assessment of the quality and safety of colonoscopy in the UK. Gut. 2013 Feb;62(2):242-9. PubMed External Web Site Policy

Lakoff J, Paszat LF, Saskin R, Rabeneck L. Risk of developing proximal versus distal colorectal cancer after a negative colonoscopy: a population-based study. Clin Gastroenterol Hepatol. 2008 Oct;6(10):1117-21; quiz 1064. PubMed External Web Site Policy

Miller RE, Lehman G. Polypoid colonic lesions undetected by endoscopy. Radiology. 1978 Nov;129(2):295-7. PubMed External Web Site Policy

Pabby A, Schoen RE, Weissfeld JL, Burt R, Kikendall JW, Lance P, Shike M, Lanza E, Schatzkin A. Analysis of colorectal cancer occurrence during surveillance colonoscopy in the dietary Polyp Prevention Trial. Gastroenterol Endosc. 2005 Mar;61(3):385-91. PubMed External Web Site Policy

Park WG, Cohen J. Quality measurement and improvement in upper endoscopy. Gastroenterol Endosc. 2012;14:13-20.

Pickhardt PJ, Choi JR, Hwang I, Butler JA, Puckett ML, Hildebrandt HA, Wong RK, Nugent PA, Mysliwiec PA, Schindler WR. Computed tomographic virtual colonoscopy to screen for colorectal neoplasia in asymptomatic adults. N Engl J Med. 2003 Dec 4;349(23):2191-200. [31 references] PubMed External Web Site Policy

Pickhardt PJ, Nugent PA, Mysliwiec PA, Choi JR, Schindler WR. Location of adenomas missed by optical colonoscopy. Ann Intern Med. 2004 Sep 7;141(5):352-9, W-66. PubMed External Web Site Policy

Pohl H, Srivastava A, Bensen SP, Anderson P, Rothstein RI, Gordon SR, Levy LC, Toor A, Mackenzie TA, Rosch T, Robertson DJ. Incomplete polyp resection during colonoscopy-results of the complete adenoma resection (CARE) study. Gastroenterology. 2013 Jan;144(1):74-80. PubMed External Web Site Policy

Raftopoulos SC, Segarajasingam DS, Burke V, Ee HC, Yusoff IF. A cohort study of missed and new cancers after esophagogastroduodenoscopy. Am J Gastroenterol. 2010 Jun;105(6):1292-7. PubMed External Web Site Policy

Rajasekhar PT, Rutter MD, Bramble MG, Wilson DW, East JE, Greenaway JR, Saunders BP, Lee TJ, Barton R, Hungin AP, Rees CJ. Achieving high quality colonoscopy: using graphical representation to measure performance and reset standards. Colorectal Dis. 2012 Dec;14(2):1538-45. PubMed External Web Site Policy

Robertson DJ, Lieberman DA, Winawer SJ, Ahnen DJ, Baron JA, Schatzkin A, Cross AJ, Zauber AG, Church TR, Lance P, Greenberg ER, Martinez ME. Colorectal cancers soon after colonoscopy: a pooled multicohort analysis. Gut. 2014 Jun;63(6):949-56. PubMed External Web Site Policy

Rockey DC, Paulson E, Niedzwiecki D, Davis W, Bosworth HB, Sanders L, Yee J, Henderson J, Hatten P, Burdick S, Sanyal A, Rubin DT, Sterling M, Akerkar G, Bhutani MS, Binmoeller K, Garvie J, Bini EJ, McQuaid K, Foster WL, Thompson WM, Dachman A, Halvorsen R. Analysis of air contrast barium enema, computed tomographic colonography, and colonoscopy: prospective comparison. Lancet. 2005 Jan 22;365(9456):305-11. PubMed External Web Site Policy

Rutter MD, Rees CJ. Quality in gastrointestinal endoscopy. Endoscopy. 2014 Jun;46(6):526-8. PubMed External Web Site Policy

Rutter MD, Senore C, Bisschops R, Domagk D, Valori R, Kaminski MF, Spada C, Bretthauer M, Bennett C, Bellisario C, Minozzi S, Hassan C, Rees C, Dinis-Ribeiro M, Hucl T, Ponchon T, Aabakken L, Fockens P. The European Society of Gastrointestinal Endoscopy Quality Improvement Initiative: developing performance measures. Endoscopy. 2016 Jan;48(1):81-9. PubMed External Web Site Policy

Singh H, Nugent Z, Demers AA, Bernstein CN. Rate and predictors of early/missed colorectal cancers after colonoscopy in Manitoba: a population-based study. Am J Gastroenterol. 2010 Dec;105(12):2588-96. PubMed External Web Site Policy

Singh H, Nugent Z, Demers AA, Kliewer EV, Mahmud SM, Bernstein CN. The reduction in colorectal cancer mortality after colonoscopy varies by site of the cancer. Gastroenterology. 2010 Oct;139(4):1128-37. PubMed External Web Site Policy

Valori RM, Morris JE, Thomas JD, Rutter M. Tu1485 rates of post colonoscopy colorectal cancer (PCCRC) are significantly affected by methodology, but are nevertheless declining in the English NHS. Gastrointest Endosc. 2014 May;79(5 Suppl):AB558.

Van Gelder RE, Nio CY, Florie J, Bartelsman JF, Snel P, De Jager SW, Van Deventer SJ, Laméris JS, Bossuyt PM, Stoker J. Computed tomographic colonography compared with colonoscopy in patients at increased risk for colorectal cancer. Gastroenterology. 2004 Jul;127(1):41-8. PubMed External Web Site Policy

van Rijn JC, Reitsma JB, Stoker J, Bossuyt PM, van Deventer SJ, Dekker E. Polyp miss rate determined by tandem colonoscopy: a systematic review. Am J Gastroenterol. 2006 Feb;101(2):343-50. PubMed External Web Site Policy

Williams EJ, Taylor S, Fairclough P, Hamlyn A, Logan RF, Martin D, Riley SA, Veitch P, Wilkinson ML, Williamson PJ, Lombard M, BSG Audit of ERCP. Are we meeting the standards set for endoscopy? Results of a large-scale prospective survey of endoscopic retrograde cholangio-pancreatograph practice. Gut. 2007 Jun;56(6):821-9. PubMed External Web Site Policy

Williams EJ, Taylor S, Fairclough P, Hamlyn A, Logan RF, Martin D, Riley SA, Veitch P, Wilkinson ML, Williamson PR, Lombard M. Risk factors for complication following ERCP; results of a large-scale, prospective multicenter study. Endoscopy. 2007 Sep;39(9):793-801. PubMed External Web Site Policy

Yalamarthi S, Witherspoon P, McCole D, Auld CD. Missed diagnoses in patients with upper gastrointestinal cancers. Endoscopy. 2004 Oct;36(10):874-9. PubMed External Web Site Policy

Primary Health Components

Upper gastrointestinal (UGI) endoscopy; Barrett's esophagus; dysplasia; registry

Denominator Description

All patients with a diagnosis of Barrett's esophagus of at least 1 centimeter (cm) circumferential extent and histologically confirmed specialized intestinal metaplasia (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

Patients in the denominator who are registered in a Barrett's surveillance database (see the related "Numerator Inclusions/Exclusions" field)

Type of Evidence Supporting the Criterion of Quality for the Measure

  • A formal consensus procedure, involving experts in relevant clinical, methodological, public health and organizational sciences
  • A systematic review of the clinical research literature (e.g., Cochrane Review)
  • One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal

Additional Information Supporting Need for the Measure

Unspecified

Extent of Measure Testing

Unspecified

State of Use

Current routine use

Measurement Setting

Ambulatory/Office-based Care

Ambulatory Procedure/Imaging Center

Hospital Outpatient

Professionals Involved in Delivery of Health Services

Advanced Practice Nurses

Nurses

Physician Assistants

Physicians

Least Aggregated Level of Services Delivery Addressed

Single Health Care Delivery or Public Health Organizations

Statement of Acceptable Minimum Sample Size

Specified

Target Population Age

Age less than or equal to 75 years

Target Population Gender

Either male or female

National Quality Strategy Aim

Better Care

National Quality Strategy Priority

Prevention and Treatment of Leading Causes of Mortality

IOM Care Need

Living with Illness

IOM Domain

Effectiveness

Case Finding Period

Every 2 years

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Clinical Condition

Patient/Individual (Consumer) Characteristic

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
All patients with a diagnosis of Barrett's esophagus of at least 1 centimeter (cm) circumferential extent and histologically confirmed specialized intestinal metaplasia

Exclusions

  • Absence of intestinal metaplasia in the biopsies
  • All patients with suspected Barrett's esophagus that is less than C1M1 according to the Prague classification
  • Patients older than 75 years
  • Patients with contraindications for biopsies

Exclusions/Exceptions

Medical factors addressed

Numerator Inclusions/Exclusions

Inclusions
Patients in the denominator who are registered in a Barrett's surveillance database

Note:

  • Record all patients with a diagnosis of Barrett's esophagus.
  • Cross-match with registration in a Barrett's registry.

Exclusions
Unspecified

Numerator Search Strategy

Fixed time period or point in time

Data Source

Electronic health/medical record

Paper medical record

Registry data

Type of Health State

Does not apply to this measure

Instruments Used and/or Associated with the Measure

Unspecified

Measure Specifies Disaggregation

Does not apply to this measure

Scoring

Rate/Proportion

Interpretation of Score

Desired value is a higher score

Allowance for Patient or Population Factors

Unspecified

Standard of Comparison

Internal time comparison

Prescriptive standard

Prescriptive Standard

Minimum standard*: 85%

Target standard**: 85%

Note: Refer to the original measure documentation for additional information on standards.

*Minimum Standard: A minimum defined level of performance within a performance measure.

**Target Standard: A desirable/aspirational level of performance within a performance measure.

Evidence for Prescriptive Standard

Bisschops R, Areia M, Coron E, Dobru D, Kaskas B, Kuvaev R, Pech O, Ragunath K, Weusten B, Familiari P, Domagk D, Valori R, Kaminski MF, Spada C, Bretthauer M, Bennett C, Senore C, Dinis-Ribeiro M, Rutter MD. Performance measures for upper gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. Endoscopy. 2016 Sep;48(9):843-64. PubMed External Web Site Policy

Original Title

Barrett's patient registry.

Measure Collection Name

Upper Gastrointestinal Endoscopy Performance Measures

Measure Set Name

Post-procedure

Submitter

European Society of Gastrointestinal Endoscopy

Developer

European Society of Gastrointestinal Endoscopy

Funding Source(s)

European Society of Gastrointestinal Endoscopy (ESGE) and United European Gastroenterology (UEG)

Composition of the Group that Developed the Measure

The European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Committee (QIC) membership comprises the QIC chairperson, ESGE president and president-elect, chairs of the other three ESGE committees (guidelines, education and research) and chairs of QIC working groups.

Financial Disclosures/Other Potential Conflicts of Interest

Competing Interests

  • R. Bisschops has received consultancy fees from Boston Scientific (2015); speaker's fees from Covidien (2009 to 2016) and Norgine (2015); speaker's fee and hands-on training sponsorship from Olympus Europe (2013 to 2014); consultancy fees, speaker's fee, and research support from Pentax Europe (2008 to 2016) and Fujifilm (2013 to 2016); research support from Cook Medical (2015 to 2016); hands-on training sponsorship from Erbe (2013 to 2015); and an editorial fee from Thieme Verlag as coeditor of Endoscopy.
  • E. Coron has received consultancy fees from Mauna Kea Technologies (2011 to 2015) and Covidien (2015 to 2016); speaker's fees from Olympus and Cook Medical; and receives research support from Fujifilm and Mauna Kea Technologies.
  • O. Pech has received speaker's fees from Medtronic, Boston Scientific, Olympus, Fujifilm, and Norgine.
  • K. Ragunath has received educational grants, speaker honorarium, and consultancy fees from Olympus; educational grants and research support from COOK; educational grants and research support from Covidien; consultancy fees and research support from Boston Scientific; research support from Astra Zeneca; research support from Pentax.
  • B. Weusten has received financial support for institutional review board (IRB)-approved studies from GI Solutions and Covidien, ERBE, and C2Therapeutics.
  • R. Valori is a director of Quality Solutions for Healthcare, a company providing consultancy for improving quality in healthcare, and of AnderVal Ltd., a company providing endoscopy skills training.
  • C. Spada has received training support from Given Imaging (2013 and 2014).
  • M. Bretthauer receives funds from Thieme Verlag for editorial work for Endoscopy.
  • C. Bennett owns and works for Systematic Research Ltd.; and received a consultancy fee from ESGE to provide scientific, technical, and methodological expertise for the present project.
  • C. Senore's department receives PillCam Colon devices from Covidien-Given to conduct studies, and loaner Fuse systems from EndoChoice.
  • M. Dinis-Ribeiro receives funds from Thieme Verlag for editorial work for Endoscopy; his department has received support from Olympus for a teaching protocol (from August 2014 to July 2015).
  • M. D. Rutter's department receives research funding from Olympus for a colitis surveillance trial (2014 to present).
  • M. Areia, D. Dobru, B. Kaskas, R. Kuvaev, P. Familiari, D. Domagk, and M. F. Kaminski have no competing interests.

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2016 Sep

Measure Maintenance

Unspecified

Date of Next Anticipated Revision

Unspecified

Measure Status

This is the current release of the measure.

Source(s)

Bisschops R, Areia M, Coron E, Dobru D, Kaskas B, Kuvaev R, Pech O, Ragunath K, Weusten B, Familiari P, Domagk D, Valori R, Kaminski MF, Spada C, Bretthauer M, Bennett C, Senore C, Dinis-Ribeiro M, Rutter MD. Performance measures for upper gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. Endoscopy. 2016 Sep;48(9):843-64. PubMed External Web Site Policy

Measure Availability

Source available from the European Society of Gastrointestinal Endoscopy (ESGE) Web site External Web Site Policy.

For more information, contact ESGE at c/o Hamilton Services GmbH, Landwehr Str. 9, 80336 Munich Germany; Phone: + 49 - 89 - 907 7936-11; Fax: + 49 - 89 - 907 7936-20; E-mail: secretariat@esge.com; Web site: www.esge.com External Web Site Policy.

Companion Documents

The following is available:

  • Rutter MD, Senore C, Bisschops R, Domagk D, Valori R, Kaminski MF, Spada C, Bretthauer M, Bennett C, Bellisario C, Minozzi S, Hassan C, Rees C, Dinis-Ribeiro M, Hucl T, Ponchon T, Aabakken L, Fockens P. The European Society of Gastrointestinal Endoscopy Quality Improvement Initiative: developing performance measures. Endoscopy. 2016 Jan;48(1):81-9. Available from the European Society of Gastrointestinal Endoscopy (ESGE) Web site External Web Site Policy.

NQMC Status

This NQMC summary was completed by ECRI Institute on December 14, 2016. The information was verified by the measure developer on February 13, 2017.

Copyright Statement

This NQMC summary is based on the original measure, which is subject to the measure developer's copyright restrictions.

Contact Dr. Regina Wenzel at Regina.Wenzel@thieme.de for all questions about use and reproduction.

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