Aroori, S.; Little, B.; Carey, P.D.; Archbold, J.A.A.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA70
Academic Journal
Aim: To evaluate whether upper gastrointestinal endoscopy (UGE) is used appropriately according to the British (BSG) and American Society of Gastrointestinal Endoscopy (ASGE) guidelines in a hospital setting and whether there is any relationship between appropriateness of UGE and the presence of lesions detectable by endoscopy. Materials and Methods: Indications and endoscopic findings for 525 consecutive UGE performed in 500 patients, between Jan 1995 and Dec 2000 in Downe Hospital, retrospectively evaluated using BSG and ASGE guidelines to determine appropriateness of referrals. The endoscopic findings that had direct therapeutic or prognostic consequences were classified as positive; the other were classified as negative. Results: There were 237 male and 263 female patients with mean age 57.3 years (range: 17-94). In all, 62.9% of UGEs were positive, 37.1% were negative, and 22.7% and 26.7% were inappropriate according to BSG and ASGE guidelines, respectively (p = 0.024). The probability of finding a positive endoscopy was significantly higher in UGE rated as appropriate on the basis of both BSG (p < 0.0001) and ASGE guidelines (p = 0.002). Endoscopies rated as inappropriate according to BSG and ASGE guidelines showed a positive finding in 46.2% and 52.1% of cases, respectively. On multivariate analysis, the positive findings are directly related to age (p = 0.034), male gender (p = 0.006) and inversely related to upper abdominal pain (p < 0.0001) and nausea and vomiting (p = 0.0001). Inpatient referrals showed more positive findings compared with outpatient and open access referrals (p = 0.01). Conclusions: UGE is frequently used for inappropriate indication. The actual usefulness of appropriateness criteria as proposed by BSG and ASGE is questionable: as their strict observance could lead to missing a large number of significant positive findings.


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