Are gastroenterologists willing to implement imaging-guided surveillance for Barrett’s esophagus? Results from a national survey

Abstract

Introduction: The American Society for Gastrointestinal Endoscopy (ASGE) has published a Preservation and Incorporation of Valuable Endoscopic Innovations (PIVI) statement on incorporating an imaging-guided surveillance protocol to replace the current practice of four-quadrant biopsies every two centimeters for Barrett’s esophagus (BE) surveillance. We sought to determine if current gastroenterologists would be willing to apply these changes to their practice and identify any barriers to implementation. Methods: We collected data using surveys that were distributed at two national meetings and using a random selection process emailed surveys to members listed in the American Gastroenterological Association directory. Physicians from a variety of practice settings participated. Primary outcomes of our study included determining whether clinicians would be willing to accept an imaging-based surveillance protocol, their reasons for not doing so, and whether a financial incentive would be persuade them to implement the protocol. Continuous variables were reported as mean ± standard deviation. Categorical variables were summarized with percentages and 95 % confidence intervals. Results: Gastroenterologists (172) completed the survey; and 140 (81.4 %) of them stated they would implemented the PIVI recommendations into practice. Using a multivariate analysis of the data, physicians who reported a financial incentive for submitting biopsy specimens to pathology were less likely to implement the PIVI recommendations. The two main barriers to implementation of the protocol were medical-legal and financial reasons. Of the 32 gastroenterologists who were not willing to implement the imaging-guided surveillance protocol, 20 (62.5 %) stated that they would implement it if there were a financial incentive. Discussion: The PIVI statement focuses on re-evaluating our current method of surveillance for BE. The results of our survey show that gastroenterologists may be willing to implement an imaging-guided surveillance program, but concerns regarding financial compensation and proper training in advanced imaging techniques remain.

A Survey of Expert Practice and Attitudes Regarding Advanced Imaging Modalities in Surveillance of Barrett’s Esophagus

“…Interestingly, non-US experts were also more likely to recommend 1–2 year surveillance intervals in NDBE patients and more likely to use BE length to determine surveillance intervals. The reasons for these differences in practice patterns are unclear and need to be addressed in future studies [32, 33]. Despite the higher utilization of CC in the non-US group, VC was still the most widely used AIM during BE surveillance regardless of endoscopist location.…”

AGA White Paper: Training and Implementation of Endoscopic Image Enhancement Technologies

“…Although early adopters of new technologies can be successful in implementing new practices by following the previously mentioned framework, widespread implementation is likely to require buy in from other key stakeholders including payors/purchasers and patients. 24,25 Payors are unlikely to be willing to pay additional money to endoscopists for obtaining in vivo optical diagnosis until endoscopists can demonstrate value in this practice through achieving similar quality outcomes with reduced cost or improved quality outcomes at similar or reduced cost. A transition toward bundled/episode payment models by payors and purchasers may promote implementation by endoscopists because endoscopists will be assuming the financial risk and the responsibility for acceptable quality for all aspects of the endoscopic procedure (including pathology).…”

Impediments to implementation of real-time pathology prediction in Barrett’s esophagus and colorectal polyps

“…In this issue of Endoscopy International Open, Appannagari et al remind us that incorporating new endoscopic management paradigms can be complex 13 . Approximately 20 % of gastroenterologists responding to a survey indicated they would be unwilling to incorporate the management paradigm proposed in the ASGE Barrett’s esophagus PIVI into their practice, because of concerns about medical-legal risk and lack of financial incentives.…”