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  • Quality indicators for Barrett’s endotherapy (QBET): UK consensus statements for patients undergoing endoscopic therapy for Barrett’s neoplasia

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Endoscopy
Original research
Quality indicators for Barrett’s endotherapy (QBET): UK consensus statements for patients undergoing endoscopic therapy for Barrett’s neoplasia
  1. Durayd Alzoubaidi1,
  2. Krish Ragunath2,
  3. Sachin Wani3,
  4. Ian D Penman4,
  5. Nigel John Trudgill5,
  6. Marnix Jansen6,
  7. Matthew Banks7,
  8. Pradeep Bhandari8,
  9. Allan John Morris9,
  10. Robert Willert10,
  11. Phil Boger11,
  12. Howard L Smart12,
  13. Narayanasamy Ravi13,
  14. Jason Dunn14,
  15. Charles Gordon15,
  16. Jayan Mannath16,
  17. Inder Mainie17,
  18. Massi di Pietro18,
  19. Andrew M Veitch19,
  20. Sally Thorpe20,
  21. Cormac Magee21,22,
  22. Martin Everson20,
  23. Sarmed Sami20,
  24. Paul Bassett23,
  25. David Graham20,
  26. Stephen Attwood24,
  27. Oliver Pech25,
  28. Prateek Sharma26,
  29. Laurence B Lovat27,
  30. Rehan Haidry28
  1. 1 Division of Surgery and Interventional Science, University College London (UCL), London, UK
  2. 2 Department of Gastroenterology, Queens Medical Centre, University Hospital Nottingham, Nottingham, UK
  3. 3 Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
  4. 4 Gastrointestinal Unit, Western General Hospital, Edinburgh, UK
  5. 5 Gastroenterology, Sandwell General Hospital, West Bromwich, UK
  6. 6 Department of Histopathology, University College London Hospital, London, UK
  7. 7 Department of Gastroenterology, University College London Hospital, London, UK
  8. 8 Department of Gastroenterology, Queen Alexandra Hospital Portsmouth, Portsmouth, UK
  9. 9 Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, UK
  10. 10 Department of Gastroenterology, Manchester Royal Infirmary, Manchester, UK
  11. 11 Department of Gastroenterology, University Hospital Southampton, Southampton, UK
  12. 12 Department of Gastroenterology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, Merseyside, UK
  13. 13 Division of Surgery, St James’s Hospital, Dublin, Ireland
  14. 14 Department of Gastroenterology, Guy's and St Thomas' Hospital, London, UK
  15. 15 Department of Gastroenterology, Royal Bournemouth Hospital, Bournemouth, UK
  16. 16 Department of Gastroenterology, Coventry and Warwickshire NHS Trust, Coventry, UK
  17. 17 Department of Gastroenterology, Belfast City Hospital, Belfast, UK
  18. 18 MRC Cancer Unit, University of Cambridge, Cambridge, UK
  19. 19 Department of Gastroenterology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
  20. 20 Department of Gastroenterology, University Colleg London Hospital, London, UK
  21. 21 Department of Gastroenterology, University College London Hospital, Londons, UK
  22. 22 Metabolism and Experimental Therapeutic, University College London Division of Biosciences, London, UK
  23. 23 Statsconsultancy, Amersham, UK
  24. 24 Department of Health Services Research, Durham University, Durham, UK
  25. 25 Department of Medicine, HSK Wiesbaden, Wiesbaden, Germany
  26. 26 Department of Gastroenterology, University of Kansas, Kansas City, Kansas, USA
  27. 27 Division of Surgery and Interventional Science, University College London (UCL), Londons, UK
  28. 28 Department of Gastroenterology and Division of Surgery and Interventional Science, University College London Hospitals NHS Foundation Trust, London, UK
  1. Correspondence to Dr Durayd Alzoubaidi, Division of Surgery and Interventional Science, University College London, London W1W 7TS, UK; d.alzoubaidi{at}ucl.ac.uk

Abstract

Introduction Endoscopic therapy for the management of patients with Barrett’s oesophagus (BE) neoplasia has significantly developed in the past decade; however, significant variation in clinical practice exists. The aim of this project was to develop expert physician-lead quality indicators (QIs) for Barrett’s endoscopic therapy.

Methods The RAND/UCLA Appropriateness Method was used to combine the best available scientific evidence with the collective judgement of experts to develop quality indicators for Barrett’s endotherapy in four subgroups: pre-endoscopy, intraprocedure (resection and ablation) and postendoscopy. International experts, including gastroenterologists, surgeons, BE pathologist, clinical nurse specialist and patient representative, participated in a three-round process to develop 15 QIs that fulfilled the RAND/UCLA definition of appropriateness.

Results 17 experts participated in round 1 and 20 in round 2. Of the 24 proposed QIs in round 1, 20 were ranked as appropriate (put through to round 2) and 4 as uncertain (discarded). At the end of round 2, a final list of 15 QIs were scored as appropriate.

Conclusions This UK national consensus project has successfully developed QIs for patients undergoing Barrett’s endotherapy. These QIs can be used by service providers to ensure that all patients with BE neoplasia receive uniform and high-quality care.

  • Barrett’s Oesophagus
  • endoscopy
  • Endoscopic Mucosal Resection (EMR)
  • Endoscopic Submucosal Dissection (ESD)
  • Radio Frequency Ablation (RFA)

https://doi.org/10.1136/flgastro-2019-101247

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    Footnotes

    • Presented at This study was previously presented as an abstract at UEGW 2018.

    • Contributors DA is the first author, and has written and submitted the manuscript, and was directly involved with the planning, analysis, data search and critique of this paper. KR, SW, IDP, NJT, MJ, MB, PrB, AJM, RW, PhB, HLS, NR, JD, CG, JM, IM, MdP, AMV, ST, CM, ME, SS, DG, SA, OP, PS and LBL were directly involved with the planning and critique of this paper and provided intellectual input to this paper. PaB significantly contributed to the statistical analysis and critique of this paper. RH was directly involved in the planning, analysis, data search and critique of this paper, and is the senior author. All authors contributed to the refinement of the paper and approved the final manuscript.

    • Funding This project received funding from the BSG to cover travel expenses endured by the investigators in order to attend the face-to-face meeting in London for round 2 voting.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.