Bersani Gianluca, Rossi Angelo, Suzzi Alessandra, Ricci Giorgio, De Fabritiis Giovanni, Alvisi Vittorio
Department of Clinical and Experimental Medicine, Unit of Endoscopy Malatesta Novello Cesena, Post-Graduate School of Gastroenterology, University of Ferrara, Ferrara, Italy.
Am J Gastroenterol. 2004 Nov;99(11):2128-35. doi: 10.1111/j.1572-0241.2004.40078.x.
The aim of this study was to compare the diagnostic performance of the two systems for the evaluation of the appropriateness of upper digestive endoscopy suggested by the American Society of Gastrointestinal Endoscopy (ASGE) and by the European Panel on the Appropriateness of Gastrointestinal Endoscopy (EPAGE).
Patients referred for the upper digestive endoscopy (EGD) to a University Outpatients Clinic of Northeastern Italy were consecutively included in this prospective observational study. Before the EGD, the endoscopist assigned the patients to one of the ASGE appropriateness classes; another endoscopist then identified the detailed clinical scenario for the patients, which corresponds to scenarios examined by EPAGE by using a nine-point scale: 1-3 inappropriate; 4-6 uncertain; and 7-9 appropriate. The relationship between the appropriateness of use and the presence of relevant endoscopic lesions (neoplasms, ulcers, esophagitis, erosive gastritis/duodenitis, stenosis, and varices) was assessed, calculating the sensitivity and the specificity for each of the ASGE criteria, and each of the EPAGE scores, and plotting them to form a receiver operating characteristic (ROC) curve. The area under the ROC curve (AUC) provides a summary measure of test performance, and can vary from a minimum of 0.5 to a maximum of 1.0. We compared the AUC of the ROC curve derived from the ASGE criteria against that derived from the EPAGE criteria.
A total of 2,300 consecutive patients were included in the study (42% men; mean age: 57.3; range: 12-99); comparison of appropriateness criteria according to the ASGE and EPAGE could be made for 2,000 patients. The AUC of the ROC curve derived from the ASGE criteria was 0.553 (95% CI: 0.527-0.579), significantly higher than the AUC of the ROC curve derived from the EPAGE score: 0.523 (95% CI: 0.497-0.549; p < 0.05).
We suggest that the diagnostic yield for relevant endoscopic findings obtained by both the systems (ASGE and EPAGE) is low; slightly better results could be accomplished by the ASGE criteria.
本研究旨在比较两种系统对美国胃肠内镜学会（ASGE）和欧洲胃肠内镜适宜性专家组（EPAGE）所建议的上消化道内镜检查适宜性评估的诊断性能。
在意大利东北部一所大学门诊诊所接受上消化道内镜检查（EGD）的患者被连续纳入这项前瞻性观察性研究。在进行EGD之前，内镜医师将患者分配到ASGE适宜性类别之一；然后另一位内镜医师确定患者的详细临床情况，这与EPAGE使用九点量表检查的情况相对应：1 - 3分不适当；4 - 6分不确定；7 - 9分适当。评估使用适宜性与相关内镜病变（肿瘤、溃疡、食管炎、糜烂性胃炎/十二指肠炎、狭窄和静脉曲张）的存在之间的关系，计算每个ASGE标准以及每个EPAGE评分的敏感性和特异性，并将它们绘制成受试者操作特征（ROC）曲线。ROC曲线下面积（AUC）提供了测试性能的汇总测量，范围从最小值0.5到最大值1.0。我们比较了源自ASGE标准的ROC曲线的AUC与源自EPAGE标准的ROC曲线的AUC。
共有2300名连续患者纳入研究（42%为男性；平均年龄：57.3岁；范围：12 - 99岁）；可以对2000名患者进行ASGE和EPAGE适宜性标准的比较。源自ASGE标准的ROC曲线的AUC为0.553（95%置信区间：0.527 - 0.579），显著高于源自EPAGE评分的ROC曲线的AUC：0.523（95%置信区间：0.497 - 0.549；p < 0.05）。
我们认为这两种系统（ASGE和EPAGE）获得的相关内镜检查结果的诊断率较低；ASGE标准可能会取得稍好的结果。
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