Evaluation of the clinical impact of endoscopic ultrasonography in gastrointestinal disease.
BACKGROUND
Outcome studies evaluating the impact of endosonography on patient management are lacking. We conducted a prospective study to assess the overall clinical effectiveness of endosonography as perceived by the requesting physician.


METHODS
Physicians requesting endosonography were asked to fill out a questionnaire listing clinical diagnosis, diagnostic certainty, and future management plans. After the procedure, the requesting physicians were asked about changes in diagnosis and management, and the physicians' impressions of how clinically helpful the test was. Comparisons were made between the preprocedure and postprocedure assessment and plans, changes in diagnosis, diagnostic certainty, patient management plans, and if endosonography led to a more or less invasive course of therapy.


RESULTS
Sixty-three patients (35 women and 28 men) were evaluated. Management was altered in 30 patients (48%). In 66% of these patients the subsequent course of therapy was less invasive. Diagnostic certainty increased from 2.8 before endosonography to 4.3 after sonography (p = 0.0001). Endosonography was judged to be 4.1 on a "usefulness" score of 1 to 5.


CONCLUSIONS
Endosonography is helpful in improving diagnostic certainty, frequently leading to altered patient management, and is perceived to be a helpful test by requesting physicians.
Department of Medicine, University of Massachusetts Medical Center, Worcester, USA.
I H
IH
Jafri
J R
JR
Saltzman
J M
JM
Colby
P E
PE
Krims
D000328:Adult; D000368:Aged; D003625:Data Collection; D003937:Diagnosis, Differential; D016099:Endoscopy, Gastrointestinal / Q000706:statistics & numerical data; D005069:Evaluation Studies as Topic; D005260:Female; D005767:Gastrointestinal Diseases / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity