RESUMEN
BACKGROUND: Barrett's esophagus (BE) is a premalignant condition diagnosed using systematic 4-quadrant forceps biopsies (FB) during endoscopy. This method is fraught with errors due to the randomness of sampling and variability among operators. Wide-area transepithelial sampling with 3-dimensional computer-assisted analysis (WATS3D) is an emerging technique used to collect esophageal samples. The aim of this study was to evaluate WATS3D as a diagnostic tool for detecting BE in addition to FB, compared to FB alone. METHODS: A retrospective observational cohort study was conducted and included patients who underwent screening for BE with WATS3D and FB between January 2015 and January 2019 across 3 endoscopy centers in Wichita, Kansas. The FB specimens were reviewed by community pathologists, while the WATS3D samples were sent to CDX technology labs, NY. RESULTS: A total of 108 patients were screened for BE using both modalities concurrently. FB and WATS3D detected 62 (57.4%) and 83 (76%) cases of BE, respectively. The absolute difference of 21 cases (18.6%) of BE was attributed to the addition of WATS3D. The number needed to test with WATS3D was 5. We divided the sample into 4 groups to compare the agreement across all groups: (FB-; WATS3D+), (FB-; WATS3D-), (FB+; WATS3D+), and (FB+ and WATS3D-). Overall agreement by kappa statistic was 0.74. CONCLUSION: WATS3D identified 21 cases of BE missed by FB. Using WATS3D in addition to FB increased the yield of BE during surveillance endoscopy, with no increase in complications.
RESUMEN
INTRODUCTION: Stool assays used to diagnose Clostridioides difficile infection (CDI) do not differentiate acute CDI from asymptomatic carriers, which contributes to a falsely elevated rate of healthcare-facility onset (HO) CDI when CD stool assays are inappropriately ordered. The aim of this study was to investigate the rate of HO-CDI before and after implementing a mandatory clinical pathway prior to ordering stool tests when suspecting CDI. METHODS: A single-center retrospective observational study was conducted that spanned 12 months. All patients who developed diarrhea 48 hours after being admitted and whose primary physician requested a CD stool assay were included in the study. The intervention consisted of a mandatory sequence of questions that allowed providers to order a CD stool assay only if clinically indicated. RESULTS: Differences in HO-CDI rates pre- and post-intervention were analyzed. The HO-CDI rate during the pre-intervention and post-intervention periods were 24.1 and 0.0, respectively (p = 0.023). CONCLUSION: A marked reduction of the rate of HO-CDI occurred after implementing a mandatory clinical pathway. Setting up a mandatory pre-testing questionnaire could decrease the misclassification of asymptomatic carriers as HO-CDI and the unnecessary prescription of antibiotics in situations where it is not indicated.