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, .
Saudi J Gastroenterol. 2013 Sep-Oct;19(5):219-22. doi: 10.4103/1319-3767.118128.
BACKGROUND/AIM: 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.
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.
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.
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.
背景/目的：开放获取内镜（OAE）缩短了患者的等待时间，减轻了胃肠病医生的临床负担；然而，内镜检查的适应证以及这些内镜检查的诊断率已成为一个重要问题。本研究旨在确定 OAE 系统中上消化道（GI）内镜检查请求的适宜性。
对 2008 年所有连续进行上胃镜检查的患者进行回顾性病历审查，并根据美国胃肠内镜学会（ASGE）指南将其定义为适宜或不适宜。记录内镜检查结果并分为阳性或阴性。转诊分为胃肠病学家、内科医生、外科医生、初级保健医生或其他医生，以及门诊或住院患者。
共纳入 505 例连续患者。平均年龄为 45.3（标准差 18.1），其中 259 例（51%）为男性。31%的转诊被认为是不合适的。初级保健医生的转诊中有 47%的患者被认为不合适，而只有 19.5%的胃肠病学家转诊被认为不合适。近 37.8%的门诊转诊不合适，而仅 7.8%的住院患者转诊不合适。胃肠病学家和外科医生分别转诊的患者中异常发现分别为 78.5%和 78%，而初级保健医生转诊的患者中为 49.7%。接受内镜检查的住院患者异常发现率为 81.7%，而门诊患者为 66.6%。按频率顺序，最常见的适当适应证依次为“上腹部不适，经适当治疗试验后仍持续存在”（78.9%）、“原因不明的持续呕吐”（19.2%）、上消化道出血或不明原因缺铁性贫血（7.6%）。本研究人群中 ASGE 指南的灵敏度和特异度分别为 70.3%和 35%。
通过我们的开放获取内镜单位转诊进行内镜检查的患者中，很大一部分被认为是不合适的，不同专业之间存在显著差异。这些结果表明，如果对从业者进行适当的教育，预计会有更好的利用率。
