Open access gastroscopy in hospitalized patients.
BACKGROUND
Open access gastroscopy allows physicians to refer patients for endoscopic procedures without a prior consultation.


OBJECTIVE
To compare the safety and efficacy of OAG with gastroscopy performed after a gastroenterological consultation.


METHODS
Patients referred for gastroscopy directly (open access) or after consultation with a gastroenterologist, by physicians in the departments of internal medicine and surgery at a major tertiary center, were compared for indications, background disease, outcome and diagnostic yield. The data were collected prospectively over a 5 month period following the introduction of OAG at the center. Physicians in both departments participated in an education program on the indications and procedure of gastroscopy. For each patient referred for OAG the attending physician completed a specially designed questionnaire that had to be signed by a senior physician. Data were managed and analyzed with Excel and SPSS software.


RESULTS
The study sample comprised 494 patients, of whom 236 were referred for OAG and 258 after prior consultation. On multivariate analysis, hospitalization in the department of internal medicine was the only independent factor for OAG. Severe background disease and aspirin treatment had no effect on physician use of OAG, although they served as a "red light" for the gastroenterology consultants. There was no difference in the diagnostic yield of the procedures (26.4% normal findings for OAG and 28.3% for consultations) or in mortality rates. The main indications for referral to gastroscopy in the surgery department were melena, hematemesis and "coffee grounds," and anemia and vomiting in the internal medicine department.


CONCLUSIONS
OAG is feasible and beneficial in an academic medical center setting, with no bias in appropriateness of indications or decrease in the diagnostic yield compared to the traditional approach. More attention should be directed to safety issues by the referring physicians.
Gal
Eyal
E
Department of Gastroenterology, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel.
Levi
Zohar
Z
Shemesh
Ilana
I
Chorev
Nechama
N
Niv
Yaron
Y
D000046:Academic Medical Centers; D000368:Aged; D005260:Female; D005767:Gastrointestinal Diseases / Q000175:diagnosis; D005773:Gastroscopy; D006760:Hospitalization; D006801:Humans; D007557:Israel; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011446:Prospective Studies; D012017:Referral and Consultation