Wide Variability in Dysplasia Detection Rate and Adherence to Seattle Protocol and Surveillance Recommendations in Barrett's Esophagus: A Population-Based Analysis Using the GIQuIC National Quality Benchmarking Registry

Kolb, Jennifer M.; Davis, Christian; Williams, J. Lucas; Holub, Jennifer L.; Shaheen, Nicholas J.; Wani, Sachin

doi:10.14309/ajg.0000000000002102

Cited by 7 publications

(4 citation statements)

References 16 publications

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“…Endoscopic procedures for some chronic scenarios such as endoscopy for simple dyspepsia and colonoscopy for constipation are of particularly low yield in guiding management 65 . A recent study found significant variability among endoscopists in adherence to Seattle protocol guidelines for Barrett's esophagus (median 93.8%, IQR 18.9%) 66 . Inappropriate procedures increase medical costs, environmental hazards, and reduce quality of care, leading to a larger carbon footprint.…”

Section: Discussionmentioning

confidence: 99%

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Environmentally sustainable gastroenterology practice: Review of current state and future goals

Sonaiya,

Marino,

Agollari

et al. 2023

Digestive Endoscopy

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BackgroundThe healthcare sector contributes 4.6% of global greenhouse gas (GHG) emissions, with gastroenterology playing a significant role due to the widespread use of gastrointestinal endoscopy.MethodologyA comprehensive search of PubMed, Embase, and Cochrane Library was conducted to explore the carbon footprint in gastroenterology practice, focusing on endoscopy, in‐patient and outpatient settings, and recruitment practices. Recommendations for mitigating the carbon footprint were derived.ResultsThis narrative review analyzed 34 articles on the carbon footprint in gastroenterology practice. Carbon footprint of endoscopy in the USA is approximately 85,768 metric tons of CO2 emission annually, equivalent to 9 million gallons of gasoline consumed, or 94 million pounds of coal burned. Each endoscopy generates 2.1 kg of disposable waste (46 L volume), of which 64% of waste goes to the landfill, 28% represents biohazard waste, and 9% is recycled. The per‐case manufacturing carbon footprint for single‐use devices and reusable devices is 1.37 kg CO2 and 0.0017 kg CO2 respectively. Inpatient and outpatient services contributed through unnecessary procedures, prolonged hospital stays, and excessive use of single‐use items. Fellowship recruitment and GI conferences added to the footprint, mainly due to air travel and hotel stays.ConclusionGI endoscopy and practice contribute to the carbon footprint through the use of disposables such as single‐use endoscopes, and waste generation. To achieve environmental sustainability, measures such as promoting reusable endoscopy equipment over single‐use endoscopes, calculating institutional carbon footprints, establishing benchmarking standards, and embracing virtual platforms such as telemedicine and research meetings should be implemented.

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Section: Discussionmentioning

confidence: 99%

“…65 A recent study found significant variability among endoscopists in adherence to Seattle protocol guidelines for Barrett's esophagus (median 93.8%, IQR 18.9%). 66 Inappropriate procedures increase medical costs, environmental hazards, and reduce quality of care, leading to a larger carbon footprint.…”

Section: Minimizing Low-value Proceduresmentioning

confidence: 99%

Environmentally sustainable gastroenterology practice: Review of current state and future goals

Sonaiya,

Marino,

Agollari

et al. 2023

Digestive Endoscopy

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“…It requires a clinic or a hospital setting and an experienced operator, especially to pick up pre cursor lesions. 44…”

Section: Modalities For Screeningmentioning

confidence: 99%

Screening for Esophageal Squamous Cell Carcinoma: A Review

Kodaganur Gopinath,

Jiwnani

2023

Foregut: The Journal of the American Foregut Society

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Esophageal cancer is amongst the most common types of cancer in Asia. It is a deadly disease where incidence almost parallels mortality. It is of 2 major subtypes, adenocarcinoma being more common in the global north and squamous cell carcinoma being more common in the global south. China, Japan, India, Iran, and other Asian countries contribute to roughly 80% of the global disease burden. Fortunately, esophageal squamous cell cancers (ESCC) are also amenable for screening. Natural history studies have shown that severe dysplasia carries the highest risk of progression to ESCC. Early detection has shown to be extremely beneficial, with cure rates above 90% for precursor lesions and early-stage esophageal cancer. There are various modalities available for screening—Chinese balloon cytology is a low cost technique that can be applied for mass screening but has only moderate sensitivity (39%-62%). Recent studies have demonstrated that using methylated DNA markers and applying artificial intelligence technology can significantly improve the yield of cytology. Lugol’s chromo-endoscopy has been demonstrated to have good sensitivity and specificity (>85%), but is an invasive technique and requires operator expertise. Other image enhancing techniques such as narrow-band imaging, autofluorescence, endocytoscopy and micro-endoscopy are promising, but currently not cost effective for mass screening. There are 3 large randomized trials underway in China, initial published results have demonstrated a detection rate between 0.7% to 1.2% for ESCC and 4% to 6% for pre cursor lesions. These trials, with some of them involving >100 000 patients have demonstrated the feasibility of endoscopic screening, but long term results are awaited.

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“…Furthermore, the sampling protocol is associated with sampling error, with reported missed dysplasia rates in a quarter to half of the patients with inconspicuous neoplasia [ 7 , 8 ], which especially affects patients with a long BE segment (>10 cm) [ 9 ]. Overall, a 3.1% dysplasia detection rate is achieved during surveillance examinations [ 10 ]. Hence, despite the labour-intensive and time-consuming characteristics, many samples can be obtained with a relatively low yield for dysplasia or cancer during surveillance endoscopy of BE.…”

Section: Introductionmentioning

confidence: 99%

Optical Biopsy of Dysplasia in Barrett’s Oesophagus Assisted by Artificial Intelligence

Laan

Putten

Zhao

et al. 2023

Cancers

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Optical biopsy in Barrett’s oesophagus (BE) using endocytoscopy (EC) could optimize endoscopic screening. However, the identification of dysplasia is challenging due to the complex interpretation of the highly detailed images. Therefore, we assessed whether using artificial intelligence (AI) as second assessor could help gastroenterologists in interpreting endocytoscopic BE images. First, we prospectively videotaped 52 BE patients with EC. Then we trained and tested the AI pm distinct datasets drawn from 83,277 frames, developed an endocytoscopic BE classification system, and designed online training and testing modules. We invited two successive cohorts for these online modules: 10 endoscopists to validate the classification system and 12 gastroenterologists to evaluate AI as second assessor by providing six of them with the option to request AI assistance. Training the endoscopists in the classification system established an improved sensitivity of 90.0% (+32.67%, p < 0.001) and an accuracy of 77.67% (+13.0%, p = 0.020) compared with the baseline. However, these values deteriorated at follow-up (−16.67%, p < 0.001 and -8.0%, p = 0.009). Contrastingly, AI-assisted gastroenterologists maintained high sensitivity and accuracy at follow-up, subsequently outperforming the unassisted gastroenterologists (+20.0%, p = 0.025 and +12.22%, p = 0.05). Thus, best diagnostic scores for the identification of dysplasia emerged through human–machine collaboration between trained gastroenterologists with AI as the second assessor. Therefore, AI could support clinical implementation of optical biopsies through EC.

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Wide Variability in Dysplasia Detection Rate and Adherence to Seattle Protocol and Surveillance Recommendations in Barrett's Esophagus: A Population-Based Analysis Using the GIQuIC National Quality Benchmarking Registry

Cited by 7 publications

References 16 publications

Environmentally sustainable gastroenterology practice: Review of current state and future goals

Environmentally sustainable gastroenterology practice: Review of current state and future goals

Screening for Esophageal Squamous Cell Carcinoma: A Review

Optical Biopsy of Dysplasia in Barrett’s Oesophagus Assisted by Artificial Intelligence

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