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Appropriateness and Diagnostic Yield of Upper Gastrointestinal Endoscopy in an Open-Access Endoscopy System
BACKGROUND/AIM: Open access endoscopy (OAE) decreases the waiting time for patients and clinical burden to gastroenterologist; however, the appropriateness of referrals for endoscopy and thus the diagnostic yield of these endoscopies has become an important issue. The aim of this study was to determ...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Medknow Publications & Media Pvt Ltd
2013
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3793473/ https://www.ncbi.nlm.nih.gov/pubmed/24045595 http://dx.doi.org/10.4103/1319-3767.118128 |
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author | Aljebreen, Abdulrahman M. Alswat, Khalid Almadi, Majid A. |
author_facet | Aljebreen, Abdulrahman M. Alswat, Khalid Almadi, Majid A. |
author_sort | Aljebreen, Abdulrahman M. |
collection | PubMed |
description | BACKGROUND/AIM: Open access endoscopy (OAE) decreases the waiting time for patients and clinical burden to gastroenterologist; however, the appropriateness of referrals for endoscopy and thus the diagnostic yield of these endoscopies has become an important issue. The aim of this study was to determine the appropriateness of upper gastrointestinal (GI) endoscopy requests in an OAE system. PATIENTS AND METHODS: A retrospective chart review of all consecutive patients who underwent an upper gastroscopy in the year 2008 was performed and was defined as appropriate or inappropriate according to the American Society for Gastrointestinal Endoscopy (ASGE) guidelines. Endoscopic findings were recorded and classified as positive or negative. Referrals were categorized as being from a gastroenterologist, internist, surgeon, primary care physicians or others, and on an inpatient or out-patient basis. RESULTS: A total of 505 consecutive patients were included. The mean age was 45.3 (standard deviation 18.1), 259 (51%) of them were males. 31% of the referrals were thought to be inappropriate. Referrals from primary care physicians were inappropriate in 47% of patients while only 19.5% of gastroenterologists referrals were considered inappropriate. Nearly, 37.8% of the out-patient referrals were inappropriate compared to only 7.8% for inpatients. Abnormal findings were found in 78.5% and 78% of patients referred by gastroenterologists and surgeons respectively while in those referred by primary care physicians it was (49.7%). Inpatients referred for endoscopy had abnormal findings in (81.7%) while in out-patients it was (66.6%). The most common appropriate indications in order of frequency were “upper abdominal distress that persisted despite an appropriate trial of therapy” (78.9%), “persistent vomiting of unknown cause” (19.2%), upper GI bleeding or unexplained iron deficiency anemia (7.6%). The sensitivity and specificity of the ASGE guidelines in our study population was 70.3% and 35% respectively. CONCLUSION: A large proportion of patients referred for endoscopy through our open-access endoscopy unit are considered inappropriate, with significant differences among specialties. These results suggest that if proper education of practitioners was implemented, a better utilization would be expected. |
format | Online Article Text |
id | pubmed-3793473 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2013 |
publisher | Medknow Publications & Media Pvt Ltd |
record_format | MEDLINE/PubMed |
spelling | pubmed-37934732013-10-15 Appropriateness and Diagnostic Yield of Upper Gastrointestinal Endoscopy in an Open-Access Endoscopy System Aljebreen, Abdulrahman M. Alswat, Khalid Almadi, Majid A. Saudi J Gastroenterol Original Article BACKGROUND/AIM: Open access endoscopy (OAE) decreases the waiting time for patients and clinical burden to gastroenterologist; however, the appropriateness of referrals for endoscopy and thus the diagnostic yield of these endoscopies has become an important issue. The aim of this study was to determine the appropriateness of upper gastrointestinal (GI) endoscopy requests in an OAE system. PATIENTS AND METHODS: A retrospective chart review of all consecutive patients who underwent an upper gastroscopy in the year 2008 was performed and was defined as appropriate or inappropriate according to the American Society for Gastrointestinal Endoscopy (ASGE) guidelines. Endoscopic findings were recorded and classified as positive or negative. Referrals were categorized as being from a gastroenterologist, internist, surgeon, primary care physicians or others, and on an inpatient or out-patient basis. RESULTS: A total of 505 consecutive patients were included. The mean age was 45.3 (standard deviation 18.1), 259 (51%) of them were males. 31% of the referrals were thought to be inappropriate. Referrals from primary care physicians were inappropriate in 47% of patients while only 19.5% of gastroenterologists referrals were considered inappropriate. Nearly, 37.8% of the out-patient referrals were inappropriate compared to only 7.8% for inpatients. Abnormal findings were found in 78.5% and 78% of patients referred by gastroenterologists and surgeons respectively while in those referred by primary care physicians it was (49.7%). Inpatients referred for endoscopy had abnormal findings in (81.7%) while in out-patients it was (66.6%). The most common appropriate indications in order of frequency were “upper abdominal distress that persisted despite an appropriate trial of therapy” (78.9%), “persistent vomiting of unknown cause” (19.2%), upper GI bleeding or unexplained iron deficiency anemia (7.6%). The sensitivity and specificity of the ASGE guidelines in our study population was 70.3% and 35% respectively. CONCLUSION: A large proportion of patients referred for endoscopy through our open-access endoscopy unit are considered inappropriate, with significant differences among specialties. These results suggest that if proper education of practitioners was implemented, a better utilization would be expected. Medknow Publications & Media Pvt Ltd 2013 /pmc/articles/PMC3793473/ /pubmed/24045595 http://dx.doi.org/10.4103/1319-3767.118128 Text en Copyright: © Saudi Journal of Gastroenterology http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Article Aljebreen, Abdulrahman M. Alswat, Khalid Almadi, Majid A. Appropriateness and Diagnostic Yield of Upper Gastrointestinal Endoscopy in an Open-Access Endoscopy System |
title | Appropriateness and Diagnostic Yield of Upper Gastrointestinal Endoscopy in an Open-Access Endoscopy System |
title_full | Appropriateness and Diagnostic Yield of Upper Gastrointestinal Endoscopy in an Open-Access Endoscopy System |
title_fullStr | Appropriateness and Diagnostic Yield of Upper Gastrointestinal Endoscopy in an Open-Access Endoscopy System |
title_full_unstemmed | Appropriateness and Diagnostic Yield of Upper Gastrointestinal Endoscopy in an Open-Access Endoscopy System |
title_short | Appropriateness and Diagnostic Yield of Upper Gastrointestinal Endoscopy in an Open-Access Endoscopy System |
title_sort | appropriateness and diagnostic yield of upper gastrointestinal endoscopy in an open-access endoscopy system |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3793473/ https://www.ncbi.nlm.nih.gov/pubmed/24045595 http://dx.doi.org/10.4103/1319-3767.118128 |
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