Introduction UK practise in diagnostic oesophago-gastric-duodenoscopy (OGD) has changed little over the last 10–20 years. Currently the only quality measure relates to ability to reach the second part of the duodenum. Evidence-based quality indicators in colonoscopy pertain to the quality of views, the amount of time spent examining the mucosa and expected levels of lesion detection, in addition to completion rates. Their adoption, in combination with robust clinical governance has undoubtedly improved the detection of colorectal diseases, patient safety and patient experience. The equivalent evidence base for diagnostic OGD does not exist and this has limited development.
Benchmarking is a process measuring the practise of one organisation against its peers and may provide a basis for developing quality standards for upper GI practise. This study measures routine OGD practise in the UK and practise in a Japanese centre of excellence for endoscopy and oesophago-gastric cancers.
Methods Two experienced endoscopists recorded OGD practise in the National Cancer Centre Hospital in Tokyo. The following were recorded: net procedural time spent screening the oesophagus, stomach, and duodenum; lens cleaning, mucosa cleaning, presence of residual food; use of dye spray and narrow band imaging; picture numbers and biopsies; patient age and sex.
One experienced endoscopist recorded OGD practise during routine diagnostic lists at 3 hospitals.
Results 134 procedures were recorded, 67 in each country. The average age in the UK was 58.5 yrs (60% male) and 68.2 yrs in Japan (57% male). The average screening time in Japan was 6:51 mins, and 5:49 mins in the UK. The Japanese use advanced imaging techniques 73% of the time. They were never used in routine UK practise.
Japanese endoscopists met weekly reviewing all pathology detected and discussing therapeutic cases. All images were reviewed closely and were an essential part of decision making and education in the unit.
Conclusion Comparison of the ‘cultures of practise’ are interesting, revealing significant differences of approach in UGI examination.
In the Japanese cohort a 48% higher yield of pathological findings was achieved despite the average screening time being only one minute longer per case.
Although there are differing disease prevalence’s in the background populations, it seems likely that better cleaning of the upper GI tract, use of mucosal enhancement techniques, care in image capture, and better awareness of upper GI pathology will have significantly contributed to increased detection.
Further investigation is needed into which factors can be used as independent measures of quality in UGI examination, including time taken to examine the upper GI tract and measures of endoscopists’ lesion recognition skills (not currently assessed as part of endoscopy training).
Disclosure of Interest None Declared.
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