Appropriateness of outpatient gastrointestinal endoscopy in a non-academic hospital.
OBJECTIVE
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.


CONCLUSIONS
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.
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.
João
J
Mangualde
Marie I
MI
Cremers
Ana M
AM
Vieira
Ricardo
R
Freire
Elia
E
Gamito
Cristina
C
Lobato
Ana L
AL
Alves
Fátima
F
Augusto
Ana P
AP
Oliveira