Euroasian Journal of Hepato-Gastroenterology

Register      Login

VOLUME 6 , ISSUE 2 ( July-December, 2016 ) > List of Articles

RESEARCH ARTICLE

Appropriateness of Upper Gastrointestinal Endoscopy: Will the Diagnostic Yield Improve by the use of American Society of Gastroenterology Guidelines?

Muazzam Tahir

Citation Information : Tahir M. Appropriateness of Upper Gastrointestinal Endoscopy: Will the Diagnostic Yield Improve by the use of American Society of Gastroenterology Guidelines?. Euroasian J Hepatogastroenterol 2016; 6 (2):143-148.

DOI: 10.5005/jp-journals-10018-1187

License: CC BY-NC 4.0

Published Online: 01-07-2016


Abstract

Aim: Open access endoscopy allows physicians and general practitioners (GIs) to refer patients for endoscopy without prior outpatient consultation. This system was introduced to reduce waiting time to the procedure and subsequent diagnosis. Concerns have been raised regarding misuse of this system with increasing number of inappropriate referrals and hence more normal examinations, which has implications on a public-funded health system. The aim of this study was to assess the appropriate use of the open access system at a rural New Zealand hospital and to see if the diagnostic yield improves by following the American Society of Gastroenterology (ASGE) guidelines for upper gastrointestinal endoscopy [esophagogastroduodenoscopy (OGD)]. Materials and methods: This was a prospective study including all the patients who had OGD at Taranaki Base Hospital between December 2013 and 2014. A total of 1,019 patients had OGD during this time period. The ASGE guidelines were used to see the relationship between appropriateness of OGD and finding of a relevant endoscopic diagnosis. Results: Fifty-eight percent of the OGDs were judged to be appropriate and 42% inappropriate by the explicit criteria. No cancer was found in OGDs judged to be inappropriate. Upper gastrointestinal (GI) endoscopies judged appropriate yielded significantly more relevant lesions than those judged to be inappropriate [65% vs 32%; odds ratio 3.94, 99% confidence interval (CI) 2.78, 5.57; p < 0.01]. Conclusion: The use of ASGE guidelines increases diagnostic yield of OGDs done, which is crucial to cost-effectiveness of an open access system and makes the system more efficient in selecting and treating patients who need it the most, in an acceptable time span.


PDF Share
  1. British Society of Gastroenterology. Provision of gastrointestinal endoscopy and related services for a district general hospital. London: BSG; 1990
  2. Overuse of upper gastrointestinal endoscopy in a country with open-access endoscopy: a prospective study in primary care. Gastrointest Endosc 1997 Jan;45(1):13-19
  3. Guidelines on the diagnosis and treatment of Helicobacter pylori infection. Dig Liver Dis 2001 Jan-Feb;33(1):75-80
  4. Appropriate use of gastrointestinal endoscopy. Gastrointest Endosc 2000;52:831-837
  5. Appropriateness and diagnostic yield of upper gastrointestinal endoscopy in an open-access endoscopy unit. Endoscopy 1996 Oct;28(8):661-666
  6. Does an open access system properly utilize endoscopic resources? Gastrointest Endosc 1997 Jul;46(1):15-20
  7. Use of open access in GI endoscopy at an academic medical center. Gastrointest Endosc 1999 Oct;50(4):480-485
  8. The ASGE guidelines for the appropriate use of upper gastrointestinal endoscopy in an open access system. Gastrointest Endosc 1995 Nov;42(5):387-389
  9. ASGE guidelines for the appropriate use of upper endoscopy: association with endoscopic findings. Gastrointest Endosc 2002 Nov;56(5):714-719
  10. Doublecontrast barium meal and upper gastrointestinal endoscopy. A comparative study. Ann Intern Med 1984 Oct;101(4): 538-545
  11. Open access endoscopy in Britain: a service in evolution. Gastrointest Endosc 1998 Dec;48(6):655-656
  12. Prospective audit of gastroscopy under the “three-day rule”: a regional initiative in Italy to reduce waiting time for suspected malignancy. Aliment Pharmacol Ther 2002 May;16(5):1011-1014
  13. Predicting the appropriate use of carotid endarterectomy, upper gastrointestinal endoscopy, and coronary angiography. N Engl J Med 1990 Oct;323(17):1173-1177
  14. Appropriateness of referrals for open-access endoscopy. How do physicians in different medical specialties do? Arch Intern Med 1996 Oct;156(18):2065-2069.
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.