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. 2024 May-Jun;58(5):432-439.
doi: 10.1097/MCG.0000000000001890. Epub 2023 Jul 13.

Improving Adherence to Clinical Practice Guidelines for Managing Gastric Intestinal Metaplasia Among Gastroenterologists at a US Academic Institution

Jake Jacob  1 , Valentine Millien  2 , Scott Berger  3 , Ruben Hernaez  1   4   5 , Gyanprakash A Ketwaroo  6 , Avegail G Flores  1   5 , Jason K Hou  1   4   5 , Maria E Jarbrink-Sehgal  1 , Natalia I Khalaf  1   4   5 , Daniel G Rosen  7 , Hashem B El-Serag  3   4 , Mimi C Tan  1   5
Affiliations

Improving Adherence to Clinical Practice Guidelines for Managing Gastric Intestinal Metaplasia Among Gastroenterologists at a US Academic Institution

Jake Jacob et al. J Clin Gastroenterol. 2024 May-Jun.

Abstract

Background: Clinical guidelines reserve endoscopic surveillance after a gastric intestinal metaplasia (GIM) diagnosis for high-risk patients. However, it is unclear how closely guidelines are followed in clinical practice. We examined the effectiveness of a standardized protocol for the management of GIM among gastroenterologists at a US hospital.

Methods: This was a preintervention and postintervention study, which included developing a protocol and education of gastroenterologists on GIM management. For the preintervention study, 50 patients with GIM were randomly selected from a histopathology database at the Houston VA Hospital between January 2016 and December 2019. For the postintervention study, we assessed change in GIM management in a cohort of 50 patients with GIM between April 2020 and January 2021 and surveyed 10 gastroenterologists. The durability of the intervention was assessed in a cohort of 50 GIM patients diagnosed between April 2021 and July 2021.

Results: In the preintervention cohort, GIM location was specified (antrum and corpus separated) in 11 patients (22%), and Helicobacter pylori testing was recommended in 11 of 26 patients (42%) without previous testing. Gastric mapping biopsies were recommended in 14% and surveillance endoscopy in 2%. In the postintervention cohort, gastric biopsy location was specified in 45 patients (90%, P <0.001) and H. pylori testing was recommended in 26 of 27 patients without prior testing (96%, P <0.001). Because gastric biopsy location was known in 90% of patients ( P <0.001), gastric mapping was not necessary, and surveillance endoscopy was recommended in 42% ( P <0.001). One year after the intervention, all metrics remained elevated compared with the preintervention cohort.

Conclusions: GIM management guidelines are not consistently followed. A protocol for GIM management and education of gastroenterologists increased adherence to H. pylori testing and GIM surveillance recommendations.

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Conflict of interest statement

Jason K. Hou has received research funding from Abbvie, Celgene, Genentech, Pfizer, Eli-Lily, Arena, and American Regent. The remaining authors have no financial conflicts of interest.

Figures

Figure 1.
Figure 1.
Micheal E. DeBakey VA Medical Center (MEDVAMC) protocol for gastric intestinal metaplasia (GIM) management adapted from 2020 American Gastroenterological Association and 2019 European Society of Gastrointestinal Endoscopy guidelines. EGD: Esophagogastroduodenoscopy; HGD: High-grade dysplasia; LGD: Low-grade dysplasia; NBI: Narrow band imaging; OLGA: Operative Link on Gastritis Assessment; OLGIM: Operative Link on Gastric Intestinal Metaplasia,
Figure 2.
Figure 2.
Frequency of metrics of adherence in the pre-intervention, post-intervention, and 1-year post-intervention cohorts.
Figure 3.
Figure 3.
Reported changes in gastric intestinal metaplasia management by 10 gastroenterologists after the intervention.
See this image and copyright information in PMC

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