Are gastroenterologists willing to implement imaging-guided surveillance for Barrett's esophagus? Results from a national survey.
Are gastroenterologists willing to implement imaging-guided surveillance for Barrett's esophagus? Results from a national survey.
复制标题
DOI：
10.1055/s-0034-1391413
复制
发表时间：
2015-06
影响因子：
2.6
通讯作者：
Gupta N
中科院分区：
文献类型：
--
作者：
Appannagari A;Soudagar AS;Pietrzak C;Sharma P;Gupta N
简介：美国胃肠道内窥镜协会（ASGE）发布了一份有价值的内窥镜创新保留和整合（PIVI）声明，内容涉及纳入成像引导监测协议，以取代目前每两厘米进行四象限活检的做法，用于巴雷特食管（BE）监测。我们试图确定目前的胃肠病学家是否愿意将这些变化应用于他们的实践，并确定实施的任何障碍。 研究方法：我们收集的数据使用的调查，分布在两个国家的会议，并使用随机选择的过程中，通过电子邮件发送的调查，在美国胃肠病协会目录中列出的成员。来自各种实践环境的医生参加了会议。我们研究的主要结果包括确定临床医生是否愿意接受基于成像的监测方案，他们不这样做的原因，以及是否有经济激励措施可以说服他们实施该方案。连续变量报告为平均值±标准差。用百分比和95%置信区间总结分类变量。 结果：172名胃肠病学家完成了调查，其中140名（81.4%）表示他们将把PIVI建议付诸实践。 使用多变量分析的数据，医生谁报告的财务激励提交活检标本病理不太可能实施PIVI的建议。执行该议定书的两个主要障碍是医疗法律和财政原因。在32名不愿意实施成像引导监测方案的胃肠病学家中，20名（62.5%）表示如果有经济激励，他们将实施该方案。 讨论：PIVI声明的重点是重新评估我们当前的BE监测方法。我们的调查结果显示，胃肠病学家可能愿意实施成像引导监测计划，但对经济补偿和先进成像技术的适当培训的担忧仍然存在。
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.