title: Appropriateness and diagnostic yield of upper gastrointestinal endoscopy in an open-access endoscopy system.
abstract: OBJECTIVE
  Open access endoscopy (OAE) decreases the waiting time for patients and clinical burden to gastroenterologist; however, the appropriateness of referrals for endoscopy and thus the diagnostic yield of these endoscopies has become an important issue. The aim of this study was to determine the appropriateness of upper gastrointestinal (GI) endoscopy requests in an OAE system.
  
  
  METHODS
  A retrospective chart review of all consecutive patients who underwent an upper gastroscopy in the year 2008 was performed and was defined as appropriate or inappropriate according to the American Society for Gastrointestinal Endoscopy (ASGE) guidelines. Endoscopic findings were recorded and classified as positive or negative. Referrals were categorized as being from a gastroenterologist, internist, surgeon, primary care physicians or others, and on an inpatient or out-patient basis.
  
  
  RESULTS
  A total of 505 consecutive patients were included. The mean age was 45.3 (standard deviation 18.1), 259 (51%) of them were males. 31% of the referrals were thought to be inappropriate. Referrals from primary care physicians were inappropriate in 47% of patients while only 19.5% of gastroenterologists referrals were considered inappropriate. Nearly, 37.8% of the out-patient referrals were inappropriate compared to only 7.8% for inpatients. Abnormal findings were found in 78.5% and 78% of patients referred by gastroenterologists and surgeons respectively while in those referred by primary care physicians it was (49.7%). Inpatients referred for endoscopy had abnormal findings in (81.7%) while in out-patients it was (66.6%). The most common appropriate indications in order of frequency were "upper abdominal distress that persisted despite an appropriate trial of therapy "(78.9%),''persistent vomiting of unknown cause "(19.2%), upper GI bleeding or unexplained iron deficiency anemia (7.6%). The sensitivity and specificity of the ASGE guidelines in our study population was 70.3% and 35% respectively.
  
  
  CONCLUSIONS
  A large proportion of patients referred for endoscopy through our open-access endoscopy unit are considered inappropriate, with significant differences among specialties. These results suggest that if proper education of practitioners was implemented, a better utilization would be expected.
authors.affiliation: Department of Internal Medicine, Gastroenterology Divisions, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia; Department of Internal Medicine, Gastroenterology Divisions, The McGill University Health Center, Montreal General Hospital, McGill University, Montreal, Canada, .
authors.forename: Abdulrahman M
authors.initials: AM
authors.lastname: Aljebreen
authors.forename: Khalid
authors.initials: K
authors.lastname: Alswat
authors.forename: Majid A
authors.initials: MA
authors.lastname: Almadi
mesh_terms: D000328:Adult; D015331:Cohort Studies; D016099:Endoscopy, Gastrointestinal / Q000592:standards* / Q000639:trends; D005260:Female; D005773:Gastroscopy / Q000592:standards / Q000639:trends; D006297:Health Services Accessibility / Q000592:standards* / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000639:trends; D012017:Referral and Consultation / Q000592:standards* / Q000639:trends; D012189:Retrospective Studies; D013997:Time Factors; D014850:Waiting Lists
references.citation: Gastrointest Endosc. 1997 Jan;45(1):13-9
references.pmid: 9013164
references.citation: Am J Gastroenterol. 2004 Nov;99(11):2128-35
references.pmid: 15554991
references.citation: Ann Intern Med. 1988 Oct 15;109(8):664-70
references.pmid: 3262326
references.citation: N Engl J Med. 1990 Oct 25;323(17):1173-7
references.pmid: 2215595
references.citation: Gastrointest Endosc. 1999 Oct;50(4):480-5
references.pmid: 10502167
references.citation: Arch Intern Med. 1996 Oct 14;156(18):2065-9
references.pmid: 8862098
references.citation: Gastrointest Endosc. 2007 May;65(6):767-74
references.pmid: 17466196
references.citation: Dig Dis Sci. 2001 Dec;46(12):2695-9
references.pmid: 11768262
references.citation: Am J Gastroenterol. 2010 Jun;105(6):1327-37
references.pmid: 20029414
references.citation: Gastrointest Endosc. 2004 Apr;59(4):517-24
references.pmid: 15044888
references.citation: Gastrointest Endosc. 2000 Dec;52(6):831-7
references.pmid: 11203479
references.citation: Gastroenterol Hepatol. 2004 Mar;27(3):119-24
references.pmid: 14998463
references.citation: Gastrointest Endosc. 2002 Nov;56(5):714-9
references.pmid: 12397281
references.citation: Gastrointest Endosc. 2003 Mar;57(3):295-9
references.pmid: 12612505
references.citation: Gastrointest Endosc. 1997 Jul;46(1):15-20
references.pmid: 9260699
references.citation: Gastrointest Endosc. 1998 Jun;47(6):449-54
references.pmid: 9647367
references.citation: Aliment Pharmacol Ther. 2002 May;16(5):1011-4
references.pmid: 11966511
references.citation: Dig Liver Dis. 2010 Feb;42(2):122-6
references.pmid: 19497799
references.citation: Aliment Pharmacol Ther. 2002 Jan;16(1):105-10
references.pmid: 11856084
references.citation: Gastrointest Endosc. 2003 Feb;57(2):183-6
references.pmid: 12556781
references.citation: Endoscopy. 1996 Oct;28(8):661-6
references.pmid: 8934082
references.citation: Gastrointest Endosc. 2006 Jun;63(7):1034-6
references.pmid: 16733121