Indicaciones para esofagogastroduodenoscopia. Utilidad de las guías de la Sociedad Americana de Endoscopia Gastrointestinal (ASGE) en un hospital del bajío mexicano

Abstract

IntroductionGastrointestinal endoscopy has advanced the diagnosis and treatment of most digestive diseases. The aim of the study was to review the indications for oesophago-gastro-duodenoscopy, adherence to the ASGE guidelines in Mexico Hospital Center, and their usefulness. Material and methodsA retrospective cohort study was conducted on all cases of patients who underwent an oesophago-gastro-duodenoscopy for diagnostic purposes in the Gastrointestinal Endoscopy service of a hospital of the center of Mexico during January 2006 to December 2010. Demographic data, speciality of the referral physician and the, description of the procedure were recorded, along with the endoscopic diagnosis. Sensitivity, specificity, predictive values and likelihood ratios were calculated, using a standard endoscopic diagnosis as a reference. ResultsA total of 3,467 oesophago-gastro-duodenoscopies were reviewed. According to the ASGE guidelines, only 36.6% of them were considered adequate, with 6.4% of the all endoscopies being requested by gastroenterologists. The main reasons for referral were oesophageal reflux disease, gastrointestinal bleeding, and dyspepsia. More than half (54.8%) of the referrals with inadequate indication showed some relevant endoscopic finding. The sensitivity and specificity were 37% and 64%, respectively, as a diagnostic test for the referral diagnosis. In multiple regression analysis, the factors most associated with a relevant diagnosis, were age (greater than 40 years), be referred for specialist medical and referral diagnosis. ConclusionsThe adherence to ASGE guidelines was low, probably due to the open access system. A high percentage of relevant endoscopic findings were found in inadequate endoscopies.