Improving Adherence to Clinical Practice Guidelines for Managing Gastric Intestinal Metaplasia Among Gastroenterologists at a US Academic Institution

Authors

Jake Jacob
Valentine Millien
Scott Berger
Ruben Hernaez
Gyanprakash A Ketwaroo
Avegail G Flores
Jason K Hou
Maria E Jarbrink-Sehgal
Natalia I Khalaf
Daniel G Rosen
Hashem B El-Serag
Mimi C Tan

Publication Date

5-1-2024

Journal

Journal of Clinical Gastroenterology

DOI

10.1097/MCG.0000000000001890

PMID

37436841

PMCID

PMC10787041

PubMedCentral® Posted Date

1-1-2025

PubMedCentral® Full Text Version

Author MSS

Published Open-Access

yes

Keywords

Humans, Gastroenterologists, Gastroscopy, Stomach Neoplasms, Metaplasia, Precancerous Conditions, Helicobacter pylori, Helicobacter Infections, gastric intestinal metaplasia, Helicobacter pylori, implementation, quality improvement

Abstract

BACKGROUND: Clinical guidelines reserve endoscopic surveillance after a gastric intestinal metaplasia (GIM) diagnosis for high-risk patients. However, it is unclear how closely guidelines are followed in clinical practice. We examined the effectiveness of a standardized protocol for the management of GIM among gastroenterologists at a US hospital.

METHODS: This was a preintervention and postintervention study, which included developing a protocol and education of gastroenterologists on GIM management. For the preintervention study, 50 patients with GIM were randomly selected from a histopathology database at the Houston VA Hospital between January 2016 and December 2019. For the postintervention study, we assessed change in GIM management in a cohort of 50 patients with GIM between April 2020 and January 2021 and surveyed 10 gastroenterologists. The durability of the intervention was assessed in a cohort of 50 GIM patients diagnosed between April 2021 and July 2021.

RESULTS: In the pre-intervention cohort, GIM location was specified (antrum and corpus separated) in 11 patients (22%), and Helicobacter pylori testing was recommended in 11 of 26 patients (42%) without previous testing. Gastric mapping biopsies were recommended in 14% and surveillance endoscopy in 2%. In the post-intervention cohort, gastric biopsy location was specified in 45 patients (90%, p<0.001) and H. pylori testing was recommended in 26 of 27 patients without prior testing (96%, p<0.001). Because gastric biopsy location was known in 90% of patients (p<0.001), gastric mapping was not necessary, and surveillance endoscopy was recommended in 42% (p<0.001). One year after the intervention, all metrics remained elevated compared to the pre-intervention cohort.

CONCLUSIONS: GIM management guidelines are not consistently followed. A protocol for GIM management and education of gastroenterologists increased adherence to H. pylori testing and GIM surveillance recommendations.