title: Appropriateness of indication for upper gastrointestinal endoscopy in a Tunisian endoscopy unit.
abstract: BACKGROUND
  Upper gastrointestinal endoscopy (UGE) is an increasing and reliable procedure. Given the high costs and potential risks, appropriate indication of UGE may be facilitated by referring to qualifying criteria such as those devised by the European Panel (EPAGE). This prospective study evaluates the applicability and efficacy of these criteria in clinical practice.
  
  
  METHODS
  Cross sectional study. Consecutive patients were referred to our unit endoscopy for diagnostic upper gastrointestinal endoscopy between January 2011 and June 2011. Demographic data, indication of the procedure, and endoscopic diagnosis were collected. The appropriateness of UGE was assessed based on EPAGE II criteria before the procedure.
  
  
  RESULTS
  EPAGE criteria were applicable in 89.1% of cases. They were 78 men (48.1%) and mean age was 49 years [14 - 91]. Indications for UGE were extremely appropriate, appropriate, inappropriate and uncertain in 21.6%, 47.4%%, 8.8% and 22.2% respectively. Among patients with clinically significant lesions detected by UGE, 70.7% had an appropriate indication. Clinically significant lesions were disclosed in 59% of the appropriate group and 54% of the inappropriate group. All cancers were observed in patients with appropriate indications. Patients with appropriate indication were older than patients belonging to the inappropriate group (53.6 years versus 39.9 years, p =0,0001).
  
  
  CONCLUSIONS
  In this present study, EPAGE criteria were applicable in 89.1% and indication was judged appropriate in more than two-third of cases. However, clinical significant lesions were observed in a proportion of patients with inappropriate indication, and in some relevant clinical situations EPAGE criteria were not applicable. Therefore, even if these criteria are helpful for decision-making, final decision must however rely upon practitioner. Qualifying criteria for an appropriate selection of endoscopical procedure adapted to our population are advisable.
authors.forename: Rym
authors.initials: R
authors.lastname: Ennaifer
authors.forename: Nour
authors.initials: N
authors.lastname: Elleuch
authors.forename: Myriam
authors.initials: M
authors.lastname: Cheikh
authors.forename: Rania
authors.initials: R
authors.lastname: Hefaiedh
authors.forename: Hayfa
authors.initials: H
authors.lastname: Romdhane
authors.forename: Houda
authors.initials: H
authors.lastname: Ben Nejma
authors.forename: Najet
authors.initials: N
authors.lastname: Bel Hadj
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000175:diagnosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019564:Unnecessary Procedures / Q000706:statistics & numerical data; D055815:Young Adult