Prime Time to Focus on Gastrointestinal Endoscopy Quality Improvement

Abstract

With all the hard work and contribution by the authors and reviewers, Journal of Digestive Endoscopy (JDE), the official journal of Society of Gastrointestinal Endoscopy of India, has completed one more successful year with its impressive endoscopy-based articles under various categories. We should always take pride in how far we have come and have faith in how far we can go. We whole heartedly thank all the authors and reviewers who had sincerely contributed to JDE in 2022 and expect the same to continue for the coming year. In the past four decades, endoscopy has evolved to become an important tool in diagnosis and management of several gastrointestinal (GI) diseases. The focus on endoscopy quality not only ensures proper and effective delivery of treatment but also ensures competencyamongendoscopists. Various national societies have endorsed the quality metrics that help define the areas of endoscopy quality improvement. Various societies like American Society for Gastrointestinal Endoscopy and European Society of Gastrointestinal Endoscopy have taken the initiatives to propose several quality metrics and performance measures for endoscopy procedures.1,2 In the year 2022, we encouraged and published several articles directly or indirectly contributing to the literature on endoscopy quality improvement. Most commonly performed endoscopic procedure with wide variety of indications is esophagogastroduodenoscopy (EGD). Documentation of complete examination of esophagus, stomach, and duodenum and targeted biopsies of suspected and established lesions is very important part of EGD. It is very important to improve the detection rate of Barrett’s esophagus (BE) in our busy endoscopy practice. In a review article, Dutta has highlighted the currently available and suitable options like acetic acid-based chromoendoscopy or image-enhanced endoscopy for the identification of dysplasia.3 The detection of BE can be improved by performing adequate and systemic examination during EGD. Among all qualitymetrics, themost studied and validated are related to colonoscopy. The proposed quality metrics for colonoscopy procedure are related to bowel preparation, cecal intubation rate, adenoma detection rate, and colonoscopy withdrawal time.4–6 For identification of all possible lesions and improving the adenoma detection rate, the complete examination of large intestine with good bowel preparation is essential.6 Poor bowel preparation not only increases the duration of procedure but also increases the chances of missing the lesions ultimately leading to increased healthcare cost due to repeat colonoscopy.7 Constipation is one of the important reason for poor bowel preparation. Theoretically, prucalopride which is the agonist of serotonin type 4 receptors may augment the effect of polyethylene glycol preparation, which is considered as one of the safest and efficacious agents for bowel preparation. In a study, Singh et al, however, found that prucalopride has no additional benefit when added with standard bowel preparation in patients of constipation.8 Negative studies like this are also important if properly conducted. Training of endoscopy is an important task for the endoscopists in the teaching hospitals. Healthcare workers, especially the resident doctors, were on the frontline in the fight against coronavirus disease 2019 (COVID-19). Sonika et al in a survey found that the COVID-19 pandemic has affected the trainingof gastroenterology residents inour region immensely as the routine endoscopic services were completely disrupted in approximately 52% of institutions for varying periods during thepandemic.9Therefore, anadditionalefforthas tobetakento compensate the loss occurred to these resident doctors.