561 Appropriateness and Safety of Direct Access Endoscopy (DAE) in Hospitalized Patients

Abstract

INTRODUCTION: Direct access endoscopy (DAE) allows hospitalists to refer patients for endoscopy without first being seen by a gastroenterologist (GI), potentially decreasing wait time, improving patient turn over, and facilitating earlier discharge from the hospital. This study aims to evaluate the efficacy and safety of DAE for low-risk endoscopic procedures. DAE has previously been employed in an outpatient setting, but this is the first study exploring DAE use in an inpatient setting in the US. METHODS: A retrospective chart review was performed comparing patients who underwent a DAE requested by hospitalists, with patients who underwent an endoscopy ordered by GI physicians from August 2017 till December 2018 at a tertiary medical center. The indication for each procedure obtained from endoscopy reports and hospitalist progress notes prior to each procedure. The appropriateness of each procedure was determined based on guidelines from the American Society for Gastrointestinal Endoscopy (ASGE). Endoscopic procedures were performed by the same endoscopist on the same day and findings were recorded and clinical significance was determined. Major complication(s) that occurred during and after the procedure were also assessed. RESULTS: A total of 110 patients were included in this study; 40 were DAE and 70 were ordered by GI physicians. The mean age was 55.5 years with 69 males and 41 females. In the DAE group, there were 31 EGD and 9 colonoscopies ordered, while in the GI group, there were 58 EGD, 11 colonoscopies, and 1 enteroscopy ordered. All of the procedures met ASGE criteria, with 73 procedures having clinically relevant findings. Of these 73 procedures, 20 were DAE (50% had clinically significant findings) and 53 were ordered by GI physicians (76% had clinically significant findings). There were two major complications: one was an apneic episode during the procedure (DAE patient); the other was oozing from a major vessel during the procedure (GI patient). CONCLUSION: DAE allows a physician to send a patient for an endoscopy without prior consultation with a GI physician. This study showed that all of the procedures requested by hospitalists met ASGE criteria for appropriateness, with 50% having clinically-relevant findings. There was no difference in adverse events between the groups. These results suggest that DAE is effective and safe in evaluating hospitalized patients for low-risk endoscopy.