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QUALITY OF CARE ASSESSMENT IN BARRETT’S ESOPHAGUS: THE EFFECT OF GUIDELINES
A Ramji, J Amar, H Chaun, L Halparin, S Whittaker, R Enns
St Paul’s Hospital, Department of Medicine, University of British Columbia, Vancouver, British Columbia
OBJECTIVE: To assess the quality of care in Barrett’s esophagus, and compare current practices to those prior to the 1998 American Association of Gastroenterology guidelines on Barrett’s esophagus.
METHODS AND MATERIALS: Retrospective chart review of 108 patients, with 151 upper endoscopies diagnosed with Barrett’s esophagus at a teaching hospital in British Columbia. Patients were divided into 2 groups; group 1: prior to publication of the guidelines (1995-1998), and group 2: after publication (1999-2001). All patients had biopsy proven Barrett’s esophagus. Quality of care assessed: identification of landmarks, presence / absence of esophagitis and hiatus hernia. Adequate biopsy number was 4 or more every 2 cm. of Barrett’s. In patients with no endoscopic Barrett’s, 3 or more biopsies was considered adequate.
RESULTS: Of the 151 cases, 63 (42%) were assessed prior to the guidelines. A first diagnosis of Barrett’s esophagus was made in 89 (59%) cases. The mean age was 59 years, and 78% of cases were male. Barrett’s epithelium was correctly identified in 109 (72%) cases at endoscopy. The z-line was noted in 24 (38%) cases in group 1, and 43 (49%) cases in group 2 (non-significant). Documentation of presence / absence of hiatus hernia was more frequent in group 2 than 1 (81% vs. 50%), p<0.001. Also, esophagitis was more frequently documented in group 2 (61% vs. 29%), p<0.001. Group 2 had a greater proportion of adequate number of biopsies (47% vs. 11%), p<0.001, OR7.4 (CI 95% 2.6-21). In cases with no endoscopic appearance of Barrett’s, there was no statistical difference in biopsy adequacy between groups 1 and 2 (50% vs. 78%). 5 patients were diagnosed with dysplasia.
CONCLUSION: Quality of care in Barrett’s esophagus has improved since publication of the 1998 guidelines. However, further attention should be given to identification and / or documentation of endoscopic findings and obtaining adequate numbers of biopsies.