Gastroenterology Unit, National Institute of Gastroenterology "S. De Bellis" Research Hospital, Via Turi 27, 70013, Castellana Grotte, Ba, Italy.
Gastroenterology and Digestive Endoscopy Unit, Ospedale Santa Chiara, Trento, Italy.
Intern Emerg Med. 2019 Mar;14(2):301-308. doi: 10.1007/s11739-018-1992-x. Epub 2018 Nov 29.
Modern medicine provides almost infinite diagnostic and therapeutic possibilities if compared to the past. As a result, patients undergo a multiplication of tests and therapies, which in turn may trigger further tests, often based on physicians' attitudes or beliefs, which are not always evidence-based. The Italian Association of Hospital Gastroenterologists and Endoscopists (AIGO) adhered to the Choosing Wisely Campaign to promote an informed, evidence-based approach to gastroenterological problems. The aim of this article is to report the five recommendations of the AIGO Choosing Wisely Campaign, and the process used to develop them. The AIGO members' suggestions regarding inappropriate practices/interventions were collected. One hundred and twenty-one items were identified. Among these, five items were selected and five recommendations were developed. The five recommendations developed were: (1) Do not request a fecal occult blood test outside the colorectal cancer screening programme; (2) Do not repeat surveillance colonoscopy for polyps, after a quality colonoscopy, before the interval suggested by the gastroenterologist on the colonoscopy report, or based on the polyp histology report; (3) Do not repeat esophagogastroduodenoscopy in patients with reflux symptoms, with or without hiatal hernia, in the absence of different symptoms or alarm symptoms; (4) Do not repeat abdominal ultrasound in asymptomatic patients with small hepatic haemangiomas (diameter < 3 cm) once the diagnosis has been established conclusively; (5) Do not routinely prescribe proton pump inhibitors within the context of steroid use or long-term in patients with functional dyspepsia. AIGO adhered to the Choosing Wisely Campaign and developed five recommendations. Further studies are needed to assess the impact of these recommendations in clinical practice with regards to clinical outcome and cost-effectiveness.
与过去相比，现代医学提供了几乎无限的诊断和治疗可能性。因此，患者接受了大量的测试和治疗，而这些治疗又可能引发更多的测试，而这些测试往往是基于医生的态度或信念，而这些态度或信念并不总是基于证据的。意大利医院胃肠病学家和内镜学家协会（AIGO）遵循明智选择运动，以促进对胃肠病问题的知情、基于证据的方法。本文的目的是报告 AIGO 明智选择运动的五项建议，以及制定这些建议的过程。收集了 AIGO 成员关于不适当的做法/干预措施的建议。确定了 121 个项目。其中，选择了五个项目并制定了五个建议。制定的五个建议是：（1）不在结直肠癌筛查计划之外要求进行粪便潜血试验；（2）在质量良好的结肠镜检查后，在结肠镜报告中内科医生建议的间隔之前，或根据息肉组织学报告，无需重复对息肉进行监测性结肠镜检查；（3）对于有反流症状、伴或不伴食管裂孔疝的患者，在没有不同症状或警报症状的情况下，不要重复进行食管胃十二指肠镜检查；（4）一旦明确诊断出直径<3cm 的小肝血管瘤，无需在无症状患者中重复进行腹部超声检查；（5）在类固醇使用或功能性消化不良患者长期使用的情况下，不要常规开具质子泵抑制剂。AIGO 遵循明智选择运动并制定了五项建议。需要进一步研究这些建议在临床实践中对临床结果和成本效益的影响。
