Journal Article

P199 Factors affecting adherence to british society of gastroenterology (BSG) guidelines on photo-documentation (PD) during diagnostic oesophagogastroduodenoscopy (OGD)

Diston, Rebecca, Alexakis, Christopher, Findlay, Ross

2024

Overview

IntroductionBSG guidance for OGD recommends 8 landmarks for PD during a diagnostic procedure, including the second part of the duodenum, the bulb, pylorus, incisura, gastric body, fundal retroflexion, gastro-oesophageal junction, and the upper oesophagus.1 Failure to adhere to these guidelines may result in inadequate inspection and missed diagnoses. We retrospectively assessed adherence to these PD guidelines, and addressed factors that might influence adherence, within the setting of a busy secondary care endoscopy unit.MethodsA retrospect analysis of 250 consecutive OGDs was conducted over autumn 2023. Data were collected on: referral type (routine/urgent/two-week rule (TWR)/surveillance), total number of photos taken per OGD, location of photos (i.e. correct landmarks), sedation usage (throat spray/sedation/both) and level of endoscopist (medical/surgical/nurse endoscopist). Cases were excluded if the OGD was therapeutic, there were technical issues with image download or there was post-surgical anatomical variance in the upper GI tract. A senior gastroenterology trainee examined all the photos for compliance with the guidelines. A PD score between 0–8 was given for the number of correct photos (e.g. a score of 8 was allocated to any OGD where all landmarks were clearly captured). A multivariate logistic regression model was created to assess variables associated with a PD score ≥6.ResultsAfter exclusions, 195 OGDs were performed (medical 24%, surgical 19%, nurse endoscopist 57%). Mean age of patient was 60.4 years, and 58% were female. Throat spray was used in 13% of cases, sedation only in 17%, and 70% required both. The mean number of photos captured per OGD was 9. Only 8% of OGDs had all 8 recommended landmarks clearly photographed. 36% had a PD score ≥6. The proportion of OGDs in which each individual landmark was captured was: Upper oesophagus: 48%, GOJ: 92%, Fundus: 90%, Body: 30%, Incisura: 21%, Pylorus: 90%, Duodenal bulb: 54%, D2: 93%. Logistic regression analysis indicated medical endoscopists (odds ratio (OR) 5.7, 95% confidence interval (CI) 2.4–13.5, p=0.0001) and a procedure performed under TWR (OR 2.9 (95% CI 1.2–6.7, p=0.02) as independent variables associated with a PD ≥6.ConclusionsPD during OGD was poor in this study, and training of endoscopy staff is warranted to increase adherence to clinical guidelines. Endoscopist level, and urgency of procedural pathway appear to be factors that improve the likelihood of complete PD.ReferenceRey JF, Lambert R, ESGE Quality Assurance Committee. ESGE recommendations for quality control in gastrointestinal endoscopy: guidelines for image documentation in upper and lower GI Endoscopy. Endoscopy 2001 Oct;33(10):901–3. doi:10.1055/s-2001–42537.

• Publisher: BMJ Publishing Group LTD
• Subject: Anesthesia / Duodenum / Endoscopy / Esophagus / Gastroenterology / Gastrointestinal tract / Gastroscopy / Quality assurance / Quality control / Regression analysis