ASGE guidelines for the appropriate use of upper endoscopy: association with endoscopic findings.
BACKGROUND
This prospective study examined the appropriate use of EGD in an open-access system with the American Society for Gastrointestinal Endoscopy (ASGE) guidelines and determined whether the ASGE guidelines were associated with relevant endoscopic findings.


METHODS
In a cohort of 1777 consecutive patients referred for open-access EGD, the proportion of patients who underwent EGD for appropriate indications was prospectively assessed. The relationship between appropriateness and the presence of clinically relevant endoscopic diagnoses was assessed by calculating (1) the likelihood ratio, positive and negative, of the indications; and (2) the change in the probability of relevant endoscopic diagnoses in the presence of the ASGE criteria.


RESULTS
The rate for EGDs "generally not indicated" was 15.6%. Relevant endoscopic diagnoses were present in 47.4% of cases with ASGE indications versus 28.8% of patients without appropriate indications as defined by the ASGE criteria (OR: 2.23; 99% CI [1.55, 3.22]; p < 0.01). A similar difference was observed for erosive gastritis (OR: 1.86; 99% CI [1.17, 2.95]; p < 0.01), erosive esophagitis (OR: 1.48; 99% CI [0.87, 2.52]; p < 0.05), and Barrett's esophagus (OR: 9.76; 99% CI [0.72, 132]; p < 0.05). The pretest probability of finding a relevant endoscopic diagnosis was modified slightly when an ASGE indication(s) was present and decreased markedly when ASGE criteria were absent.


CONCLUSIONS
The use of the ASGE guideline for appropriate indications for EGD can improve patient selection for the procedure. However, to avoid missed diagnoses of serious disease, use of the guidelines must be tailored to the specific clinical setting.
Rossi
Angelo
A
Gastrointestinal Endoscopy Service of Malatesta Novello Hospital, Cesena, Italy.
Bersani
Gianluca
G
Ricci
Giorgio
G
Defabritiis
Giovanni
G
Pollino
Valeria
V
Suzzi
Alessandra
A
Gorini
Beatrice
B
Alvisi
Vittorio
V
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004415:Dyspepsia / Q000209:etiology; D016145:Endoscopy, Digestive System; D004935:Esophageal Diseases / Q000175:diagnosis*; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis; D019983:Guideline Adherence; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012017:Referral and Consultation; D012680:Sensitivity and Specificity; D013272:Stomach Diseases / Q000150:complications / Q000175:diagnosis*