[Appropriateness of indications for upper gastrointestinal endoscopy in open-access endoscopy units]

The indication for upper gastrointestinal endoscopy (UGE) by the general practitioner may significantly reduce the waiting time list for the exploration and accelerates the process of taking decisions in patients with upper gastrointestinal pathology. The objective of this study is to compare the appropriateness of indications for diagnostic UGE between general practitioners and gastroenterologists in open-access endoscopy units.

General practitioners were previously updated on the main indications, risks and benefits for UGE, and instructions for submitting patients to open-access units were given. The indications for UGE were analysed by means of the ASGE 1997 and EPAGE guidelines for the appropriate use of upper gastrointestinal endoscopy.

There were no statistical differences between patients referred by general practitioners or gastroenterologists with respect to gender, age, indication of UGE or the presence of alarm symptoms. According to the ASGE guidelines overuse of UGE was observed in 25 (18.4%) of 136 patients submitted by general practitioners and in 32 (18.6%) of 172 patients submitted by gastroenterologists (NS). According to the EPAGE guidelines a non-appropriated UGE was present in 16 (11.8%) of patients referred by general practitioners and by 19 (11%) of patients submitted by gastroenterologists (NS).

The level of appropriateness for UGE indication obtained by general practitioners is similar to that reached by gastroenterologists. This finding should be considered for the implementation of open-access endoscopy units in our country.