Keren Dean, Rainis Tova, Stermer Edy, Lavy Alexandra
Gastroenterology Unit, Bnai Zion Medical Center, Technion-Institute of Technology, Haifa, Israel.
Can J Gastroenterol. 2011 Feb;25(2):83-8. doi: 10.1155/2011/379014.
The appropriateness and safety of open-access endoscopy are very important issues as its use continues to increase.
To present a review of a nine-year experience with open-access upper gastrointestinal endoscopy with respect to indications, diagnostic efficacy, safety and diseases diagnosed.
A retrospective, observational case series of all patients who underwent open-access endoscopy between January 2000 and December 2008 was conducted. Indications were classified as appropriate or not appropriate according to American Society of Gastrointestinal Endoscopy (ASGE) guidelines. Endoscopic diagnoses were based on widely accepted criteria. Major complication rates were assessed.
A total of 20,620 patients with a mean age of 58 years were assessed, of whom 11,589 (56.2%) were women and 9031 (43.8%) were men. Adherence to ASGE indications led to statistically significant, clinically relevant findings. The most common indications in patients older than age 45 years of age were dyspepsia (28.5%) and anemia (19.7%) in the ASGE-appropriate group, and dyspepsia in patients younger than 45 years of age without therapy trial (6.6%) in the nonappropriate group. Of the examinations, 38.57% were normal. Hiatal hernia and nonerosive gastritis were the most common findings. Important diagnoses such as malignancies and duodenal ulcers would have been missed if endoscopies were performed only according to appropriateness. There were only two major complications and no mortalities.
Open-access upper gastrointestinal endoscopy is a safe and effective system. More relevant findings were found when adhering to the ASGE guidelines. However, using these guidelines as the sole determining factor in whether to perform an endoscopy is not advisable because many clinically relevant diagnoses may be overlooked.
随着开放式内镜检查的使用持续增加，其适用性和安全性是非常重要的问题。
对九年开放式上消化道内镜检查的适应证、诊断效能、安全性及所诊断疾病进行综述。
对2000年1月至2008年12月期间接受开放式内镜检查的所有患者进行回顾性观察病例系列研究。根据美国胃肠内镜学会（ASGE）指南将适应证分为合适或不合适。内镜诊断基于广泛接受的标准。评估主要并发症发生率。
共评估了20620例患者，平均年龄58岁，其中11589例（56.2%）为女性，9031例（43.8%）为男性。遵循ASGE适应证可得出具有统计学意义的临床相关发现。45岁以上患者中，ASGE合适组最常见的适应证是消化不良（28.5%）和贫血（19.7%），不合适组45岁以下未进行治疗试验的患者中最常见的适应证是消化不良（6.6%）。检查中，38.57%结果正常。食管裂孔疝和非糜烂性胃炎是最常见的发现。如果仅根据适应证进行内镜检查，诸如恶性肿瘤和十二指肠溃疡等重要诊断将会漏诊。仅发生了两例主要并发症，无死亡病例。
开放式上消化道内镜检查是一种安全有效的系统。遵循ASGE指南时能发现更多相关发现。然而，将这些指南作为是否进行内镜检查的唯一决定因素并不明智，因为许多临床相关诊断可能会被忽视。
