University of North Carolina at Chapel Hill, Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Chapel Hill, North Carolina.
Division of Gastroenterology and Hepatology, Oregon Health and Sciences University, Portland, Oregon.
Gastroenterology. 2018 May;154(7):1993-2003. doi: 10.1053/j.gastro.2017.12.044. Epub 2018 Feb 15.
A substantial literature documents inappropriate usage of gastrointestinal endoscopy in a variety of clinical settings. Overusage of endoscopy appears to be common, and 30% or more of procedures performed in some clinical settings have questionable indications. The potential reasons for overuse of endoscopy are multiple, and include cancer phobia, fear of medical malpractice litigation, profit motive, the investigation of "incidentalomas" found on other imaging, and underappreciation of the delayed harms of endoscopy, among other reasons. Clinical guidelines, which should limit overuse of endoscopy, may instead serve to promote it, if authors opt to be "conservative," recommending endoscopy in situations of unclear utility. Several strategies may decrease overuse of endoscopy, including careful attention to risk stratification when choosing patients to screen, adherence to guidelines for surveillance intervals for colonoscopy, the use of quality indicators to identify outliers in endoscopy utilization, and education on appropriate indications and the risks of overuse at the medical student, residency, and fellowship levels.
大量文献记录了在各种临床环境中，胃肠内窥镜检查的不当使用。内窥镜检查的过度使用似乎很常见，在某些临床环境中，30%或更多的检查操作的适应证值得怀疑。内窥镜检查过度使用的潜在原因有很多，包括癌症恐惧症、害怕医疗事故诉讼、利润动机、对其他影像学检查发现的“偶发瘤”的调查，以及对内窥镜检查的延迟危害认识不足等。临床指南本应限制内窥镜检查的过度使用，但如果作者选择“保守”，即在效用不明确的情况下建议进行内窥镜检查，那么这些指南可能反而会促进过度使用内窥镜检查。有几种策略可以减少内窥镜检查的过度使用，包括在选择筛查患者时仔细注意风险分层、遵守结肠镜检查监测间隔的指南、使用质量指标识别内窥镜使用中的异常值，以及在医学生、住院医师和研究员阶段进行适当适应证和过度使用风险的教育。
