Performance measures for small-bowel endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative

Authors: Cristiano Spada, Deirdre McNamara, Edward J. Despott, Samuel Adler, Brooks D. Cash, Ignacio Fernández-Urién, Hrvoje Ivekovic, Martin Keuchel, Mark McAlindon, Jean-Christophe Saurin, Simon Panter, Cristina Bellisario, Silvia Minozzi, Carlo Senore, Cathy Bennett, Michael Bretthauer, Mario Dinis-Ribeiro, Dirk Domagk, Cesare Hassan, Michal F. Kaminski, Colin J. Rees, Roland Valori, Raf Bisschops, Matthew D. Rutter

Abstract

The European Society of Gastrointestinal Endoscopy (ESGE) together with the United European Gastroenterology (UEG) recently developed a short list of performance measures for small-bowel endoscopy (i. e. small-bowel capsule endoscopy and device-assisted enteroscopy) with the final goal of providing endoscopy services across Europe with a tool for quality improvement. Six key performance measures for both small-bowel capsule endoscopy and for device-assisted enteroscopy were selected for inclusion, with the intention being that practice at both a service and endoscopist level should be evaluated against them. Other performance measures were considered to be less relevant, based on an assessment of their overall importance, scientific acceptability, and feasibility. Unlike lower and upper gastrointestinal endoscopy, where performance measures had already been identified, this is the first time that small-bowel endoscopy quality measures have been proposed.

Introduction

The European Society of Gastrointestinal Endoscopy (ESGE) and United European Gastroenterology (UEG) have identified the need to benchmark the quality of endoscopic procedures as a high priority. The rationale for this was recently described in a manuscript that also addressed the methodology of the current quality initiative process.

The identification of small-bowel endoscopy performance measures presents several challenges, in contrast to the situation with upper and lower gastrointestinal (GI) endoscopy, where several performance measures have been identified over recent years. To date, a specific set of quality measures for small-bowel endoscopy that could serve as a basis for quality assessment and improvement has not been produced. Moreover, in contrast to upper and lower GI endoscopy, smallbowel endoscopy encompasses two distinct modalities as the small bowel can be approached by means of a non-invasive, diagnostic modality (i. e. small-bowel capsule endoscopy [SBCE]) and/or a more invasive, diagnostic, and therapeutic modality (i. e. device-assisted enteroscopy [DAE]). Although SBCE and DAE target the same organ, they differ greatly in terms of technique, procedure, process, and outcome.

The aim of the ESGE small-bowel working group was to identify a short list of performance measures for small-bowel endoscopy that were widely applicable to endoscopy services across Europe. Performance measures refer to specific issues identified for comparison and potential improvement and they represent the minimal acceptable standard of care. This list would ideally consist of performance measures with the following characteristics: proven impact on significant clinical outcomes or quality of life; a well-defined, reliable, and simple method for measurement; opportunity for improvement; and application to all levels of endoscopy services.

Bearing in mind the lack of a previous comprehensive peerreviewed paper describing quality measures, the ESGE smallbowel working group evaluated the available evidence and/or absence of evidence in order to identify research priorities. This manuscript reports the agreed list of performance measures for small-bowel endoscopy and describes the methodological process applied in the development of these measures. Performance measures are divided into key performance measures and minor performance measures. The list of performance measures and the methodological process applied in the development of these measures are described separately for SBCE and DAE.