Do non-targeted gastric biopsies affect the management of patients, and can a simple protocol and education reduce the rate?
Frontline Gastroenterol
; 9(1): 67-72, 2018 Jan.
Article
em En
| MEDLINE
| ID: mdl-29484163
ABSTRACT
OBJECTIVE:
To determine whether development of localised protocol could reduce the number of non-targeted gastric biopsies taken at endoscopy, without risking harm from non-detection of malignant conditions.DESIGN:
Retrospective analysis of patient records over a 3-month period in 2013, repeated in 2015 following intervention.SETTING:
Two UK teaching hospitals. PATIENTS Patient record data on indication for endoscopy, endoscopy findings, histopathology results and patient outcome.INTERVENTIONS:
Guidance on upper gastrointestinal biopsy in the form of a new trust-wide protocol, as well as lecture-based education. MAIN OUTCOMEMEASURES:
Rates of non-targeted and targeted biopsies before and after intervention, and differences between grade of endoscopist.RESULTS:
Between 2013 and 2015, there was a 36% reduction in non-targeted biopsies (10.4% vs 6.7%, p=0.001), predominantly within registrar and nurse endoscopist groups, with reduction in non-targeted biopsies of 9.5% and 64%, respectively. Percentage of targeted biopsies remained relatively static, 7.9% and 8.2%. In 2013, 92% of non-targeted biopsies had no management change based on histology; in 2015 this was 90%. Of patients with alteration to management, only 0.4% and 0.7% were due to malignancy, in known high-risk patients. Reduction in non-targeted biopsies resulted in estimated annual savings in this trust of £36,000.CONCLUSION:
Development of local protocol reduces the numbers of non-targeted biopsies taken, without risk of harm from non-detection of malignant conditions, enabling a significant reduction in workload within busy histopathology services, with significant cost savings. Localised protocols are adaptable to local population demographics.
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Base de dados:
MEDLINE
Idioma:
En
Ano de publicação:
2018
Tipo de documento:
Article