Appropriateness Of Upper Gastrointestinal Endoscopy Research Articles

Appropriateness and diagnostic yield of open access gastroscopy in two tertiary centers in South-western Nigeria.

There is need for the appropriate use of gastroscopy. To determine the appropriateness of upper gastrointestinal endoscopy, and its association with significant endoscopy findings in our environment. This was a prospective study of subjects who underwent gastroscopy at two centers in south-western Nigeria between August 2020 and August 2021. Indications were classified as either appropriate or inappropriate according to the ASGE guidelines, gastroscopic findings as either significant or not significant, patients as either elderly (≥ 60 years) or not, inpatients or outpatients, and referrals as either gastroenterologist referral, or not. There were 227 subjects, 131 (57.7%) females, mean age 45 ± 13.7 years. Fifteen percent were elderly, 65.6% were gastroenterologist referrals, 14.1% were inpatients, while 45.8% had co-morbidities. Endoscopy was appropriately indicated in 81.9%, and significant endoscopy findings were detected in 95.6%. Appropriateness was not associated with significant endoscopy findings. The sensitivity, specificity and AUROC of the ASGE guidelines were 10%, 82%, and 0.46 respectively. According to our study, most procedures are appropriately indicated. However, appropriateness did not determine endoscopy yield. Larger studies are needed to determine the utility of the ASGE guidelines in our environment.

A non-invasive combined strategy to improve the appropriateness of upper gastrointestinal endoscopy.

Background and aim:Increasing the appropriateness of upper gastrointestinal endoscopy (UGIE) improves the quality of care while containing costs. The aim of this study was to improve the appropriateness of UGIE through a process involving evaluation of prescriptions and the use of a non-invasive alternative.Materials and methods:At our Endoscopy Unit of Alto Vicentino Hospital, ULSS 7 Pedemontana, a tertiary center in northeastern Italy, from 2013 to 2015, a senior endoscopist evaluated the appropriateness of all outpatient referrals for UGIE and established the proper timing. Referrals were either accepted and programmed, canceled, or substituted by a non-invasive evaluation of gastric function, determining serum levels of gastrin-17 (G17), Pepsinogen I (PGI) and II (PGII), and antibodies against Helicobacter pylori.Results:A total of 5102 requests for UGIE examinations were evaluated; 540 (10.4%) were inappropriate and had been prescribed for: gastroesophageal reflux disease (n=307), surveillance with erroneous timing (n=113), dyspepsia (n=66), other indications (n=20), and absence of written indication (n=34). Gastric function was evaluated in 282/540 patients; findings included normal values in 94 patients without proton-pump inhibitor therapy (PPI) and in 48 on PPI, active H pylori infection in 56, previous H pylori infection in 30, GERD in n=50, and atrophic gastritis in n=4. UGIE was performed in the latter 4 cases. Within 2 years (range 1-22 months) of the initial refusal, 105/504 patients underwent UGIE, with normal endoscopic findings in 71/105 (67.5%), and with no cases of cancer.Conclusions:This strategy, based on a strict control of prescriptions, is effective to increase the appropriateness while containing public health costs. The use of gastric function testing improves patient selection for UGIE endoscopy. (www.actabiomedica)

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

ABSTRACTAimOpen 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 methodsThis 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.ResultsFifty-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].ConclusionThe 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.How to cite this articleTahir M. Appropriateness of Upper Gastrointestinal Endoscopy: Will the Diagnostic Yield Improve by the use of American Society of Gastroenterology Guidelines? Euroasian J Hepato-Gastroenterol 2016;6(2):143-148.

Appropriateness of Upper Gastrointestinal Endoscopy in Children: A Retrospective Study

Upper gastrointestinal endoscopy (UGIE) is appropriate in many situations in adults and children. Recommendations for UGIE use in children were published recently by the French-language Paediatric Hepatology, Gastroenterology, and Nutrition Group (GFHGNP). We retrospectively reviewed the 293 UGIE procedures undertaken in 251 children between January 1, 2001 and June 30, 2003 by 2 senior endoscopists. The UGIE procedures were categorized as appropriate or inappropriate based on GFHGNP recommendations, and diagnostic efficiency was compared in the 2 groups with the chi2 test followed by multivariate logistic regression analysis. Of the 293 UGIE procedures, 52 (17.7%) were considered inappropriate. Diagnostic efficiency was 51% in the appropriate group versus 17.3% in the inappropriate group (odds ratio, 4.2; 95% CI, 2-8.7; P < 10(-3)). The proportion of appropriate UGIE procedures was higher among inpatients than outpatients (odds ratio, 2.51; 95% CI, 1.24-5.08; P = 0.01). Inappropriate reasons for performing UGIE included isolated failure to thrive and follow-up after neonatal esophagogastroduodenitis. Nine inappropriate UGIE procedures contributed useful information: ulcerative esophagitis in 1 patient, hemorrhagic esophagitis in 4 patients, duodenitis in 1 patient, and malabsorption in 3 patients caused in 1 case by cow's milk allergy and in 2 cases to fully documented celiac disease. UGIE was usually performed appropriately in our pediatric hospital. Inappropriate UGIE procedures were more common in outpatients than in admitted patients. Awareness of the recommendations for appropriate UGIE use needs to be improved among office-based and hospital-based physicians.

Appropriateness of upper gastrointestinal endoscopy: a hospital-based study.

Aims of this study were to evaluate: (1) whether upper gastrointestinal endoscopy (UGE) is used appropriately according to the American Society for Gastrointestinal Endoscopy (ASGE) and British Society of Gastroenterology (BSG) guidelines in a hospital setting and (2) whether there is any relationship between appropriateness of UGE and the presence of lesions detected by endoscopy. Indications and endoscopic findings for 734 consecutive UGE performed in 697 inpatients were retrospectively evaluated using ASGE and BSG guidelines to determine appropriateness of referrals. UGE showing endoscopic findings that had direct therapeutic or prognostic consequences were classified as "positive"; the other UGEs were classified as "negative." In all, 46% of UGEs were "positive," 54% "negative," and 61.7% and 23.2% of UGEs were inappropriate according to ASGE and BSG guidelines, respectively (P < 0.001). The probability of finding a positive endoscopy was significantly higher in UGE rated as appropriate than in those rated as inappropriate on the basis of ASGE guidelines (P < 0.001), but not on the basis of BSG guidelines. Endoscopies rated as inappropriate according to ASGE and BSG criteria showed a positive finding in 37.3% and 42.3% of cases, respectively (not significant difference). Multivariate analysis showed that the positive finding is directly related to age (P < 0.05), male gender (P < 0.001), prior UGE (P < 0.05), hematemesis (P < 0.001), and inversely related with upper abdominal pain (P < 0.01) and dyspepsia (P < 0.05). In hospitalized patients, UGE is frequently used for inappropriate indications, according to both ASGE and BSG guidelines. However, the actual clinical usefulness of appropriateness criteria, such as those proposed by ASGE and BSG, is questionable, as their strict observance could lead to missing a large number of significant endoscopic findings.

Appropriateness of upper gastrointestinal endoscopy: Randomized trial of algorithm-based versus free clinical decision

Appropriateness of upper gastrointestinal endoscopy: Randomized trial of algorithm-based versus free clinical decision