Impact of guidelines for endoscopy in patients with Barrett's esophagus: a multifaceted interventional study

Abstract

Objective: To evaluate the impact of a multifaceted interventional program on the compliance of hepatogastroenterologists with guidelines for Barrett's esophagus.

Design: In both 2002 and 2005, anonymous postal surveys were sent out, involving eight criteria pertaining to three main areas to assess compliance, to 245 hepatogastroenterologists based in private and public hospitals, and in the community, in a specific region of France. The multifaceted intervention was based on reminders, conferences, postal campaigns and esophageal mapping. Main outcome measures were based on biopsies for diagnosis, surveillance intervals and management of patients with high-grade dysplasia.

Results: In 2002 and 2005, survey response rates were 81.6 and 73.9%, respectively. In terms of diagnosis, compliance with the systematic performance of biopsies increased from 26.5 to 59.9% (p<0.01) and, with follow-up, from 41.0 to 52.0%, respectively (p<0.02). Management of high-grade dysplasia increased from 16.0 to 24.3% (p<0.01). Total compliance (with all criteria) was achieved by 5.0% of hepatogastroenterologists in 2002 and by 10.7% in 2005 (p<0.01).

Conclusion: The present study suggests that a multifaceted interventional program can dramatically improve physician compliance with the guidelines for Barrett's esophagus. For this reason, we recommend that national scientific societies disseminate their guidelines through targeted activity to ensure that they are followed by hepatogastroenterologists.