Hassan Cesare, Bersani Gianluca, Buri Luigi, Zullo Angelo, Anti Marcello, Bianco Maria Antonia, Di Giulio Emilio, Ficano Leonardo, Morini Sergio, Di Matteo Giovanni, Loriga Piero, Pietropaolo Vincenzo, Cipolletta Livio, Costamagna Guido
Gastroenterology and Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy.
Gastrointest Endosc. 2007 May;65(6):767-74. doi: 10.1016/j.gie.2006.12.058.
Open-access endoscopy allows physicians to directly schedule endoscopic procedures for their patients without prior consultation. An evaluation of both appropriateness and diagnostic yield of endoscopic procedures is critical when assessing the costs and benefits of endoscopy in an open-access setting. The aim of this Italian multicenter study was to assess the appropriate use of upper endoscopy (EGD) in an open-access system and to establish the yield of diagnostic information relevant to patient care.
Cross-sectional, prospective, multicenter study.
A total of 6270 patients referred to 44 Italian centers for open-access EGD during 1 month were prospectively enrolled.
The American Society for Gastrointestinal Endoscopy (ASGE) guidelines were used to assess the relation between the appropriate use of EGD and the presence of relevant endoscopic findings.
The rate for "generally not indicated" EGDs was 22.9%: 29.4% for primary care physicians and 12.9% for specialists (P < .01). A relevant endoscopic finding was detected in 2929 examinations (46.7%). The diagnostic yield was significantly higher for "generally indicated" EGDs compared with "generally not indicated" procedures (52% vs 29%; odds ratio [OR] 2.65, 99% confidence interval [CI] 2.23-3.20; P < .01). Of the 133 malignant lesions diagnosed, all but 1 were diagnosed in patients with an appropriate indication (OR >20, 99% CI 3 to >100; P < .01).
Open-access EGD is an useful procedure for clinical practice. Because most of the relevant findings were detected during examinations performed for appropriate indications, the use of ASGE guidelines emerges as crucial to the cost-effectiveness of an open-access system.
开放式内镜检查允许医生在无需事先会诊的情况下直接为患者安排内镜检查程序。在评估开放式内镜检查的成本和效益时，对内镜检查程序的适宜性和诊断率进行评估至关重要。这项意大利多中心研究的目的是评估开放式系统中胃镜检查（EGD）的合理使用情况，并确定与患者护理相关的诊断信息的产出率。
横断面、前瞻性、多中心研究。
在1个月内，共有6270名患者被转诊至意大利44个中心进行开放式EGD检查，并被前瞻性纳入研究。
采用美国胃肠内镜学会（ASGE）指南评估EGD合理使用与相关内镜检查结果之间的关系。
“一般不建议进行”的EGD检查率为22.9%：初级保健医生为29.4%，专科医生为12.9%（P <.01）。在2929次检查（46.7%）中发现了相关的内镜检查结果。与“一般不建议进行”的检查相比，“一般建议进行”的EGD检查的诊断率显著更高（52%对29%；优势比[OR]2.65，99%置信区间[CI]2.23 - 3.20；P <.01）。在诊断出的133例恶性病变中，除1例外，所有病例均在有适当指征的患者中被诊断出来（OR >20，99% CI 3至>100；P <.01）。
开放式EGD检查是一种对临床实践有用的检查方法。由于大多数相关结果是在有适当指征的检查过程中发现的，因此ASGE指南的使用对于开放式系统的成本效益至关重要。
