Brief Article
Copyright ©2011 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastrointest Endosc. Oct 16, 2011; 3(10): 195-200
Published online Oct 16, 2011. doi: 10.4253/wjge.v3.i10.195
Appropriateness of outpatient gastrointestinal endoscopy in a non-academic hospital
João Mangualde, Marie I Cremers, Ana M Vieira, Ricardo Freire, Élia Gamito, Cristina Lobato, Ana L Alves, Fátima Augusto, Ana P Oliveira
João Mangualde, Marie I Cremers, Ana M Vieira, Ricardo Freire, Élia Gamito, Cristina Lobato, Ana L Alves, Fátima Augusto, Ana P Oliveira, Gastrenterology Department Setúbal Hospital Center, São Bernardo Hospital, Setúbal 2910-446, Portugal
Author contributions: Cremers MI was responsible for the study conception and design and collaborated in data acquisition; Mangualde J participated in the study conception and design, collaborated in data acquisition and was responsible for the analysis and interpretation of the data collected and the manuscript writing; Vieira AM, Freire R, Gamito É, Lobato C, Alves AL, Augusto F and Oliveira AP were co-responsible for data acquisition.
Correspondence to: João Mangualde, MD, Gastrenterology Department Setúbal Hospital Center, São Bernardo Hospital, R. Camilo Castelo Branco, Setubal 2910-446, Portugal. joaonm@gmail.com
Telephone: +351-265549055 Fax: +351-265549525
Received: January 26, 2011
Revised: June 25, 2011
Accepted: August 10, 2011
Published online: October 16, 2011
Abstract

AIM: To assess the appropriate use and the diagnostic yield of upper gastrointestinal endoscopy and colonoscopy in this subgroup of patients.

METHODS: In total, 789 consecutive outpatients referred for gastrointestinal (GI) endoscopy [381 for esophagogastroduodenoscopy (EGD) and 408 for colonoscopy] were prospectively enrolled in the study. The American Society for Gastrointestinal Endoscopy (ASGE) guidelines were used to assess the relationship between appropriateness and the presence of relevant endoscopic findings.

RESULTS: The overall inappropriate rate was 13.3%. The indications for EGD and colonoscopy were, respectively, appropriate in 82.7% and 82.6% of the exams, uncertain in 5.8% and 2.4% and inappropriate in 11.5% and 15%. The diagnostic yield was significant higher for EGDs and colonoscopies judged appropriate and uncertain when compared with those considered inappropriate (EGD: 36.6% vs 36.4% vs 11.4%, P = 0.004; Colonoscopy: 24.3% vs 20.0% vs 3.3%, P = 0.001). Of the 25 malignant lesions detected, all but one was detected in exams judged appropriate or uncertain.

CONCLUSION: This study shows a good adherence to ASGE guidelines by the referring physicians and a significant increase of the diagnostic yield in appropriate examinations, namely in detecting neoplastic lesions. It underscores the importance that the appropriateness of the indication assumes in assuring high-quality GI endoscopic procedures.

Keywords: Gastrointestinal endoscopy; Indications; Appropriateness