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Open access gastroscopy: too much to swallow?

D D Kerrigan1, S R Brown, G H Hutchinson

  • 1University Surgical Unit, Royal Hallamshire Hospital, Sheffield, South Yorkshire.

BMJ (Clinical Research Ed.)
|February 10, 1990
PubMed
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Open access gastroscopy, where general practitioners directly refer patients, is effective and doesn't increase unnecessary procedures. Targeting older patients could improve diagnostic yield for gastroscopy.

Area of Science:

  • Gastroenterology
  • Endoscopy
  • Health Services Research

Background:

  • Gastroscopy is a common procedure for diagnosing upper gastrointestinal conditions.
  • Referral pathways can influence the efficiency and diagnostic yield of gastroscopy.

Purpose of the Study:

  • To determine the proportion of normal gastroscopy findings in patients referred via different pathways.
  • To evaluate the impact of age-targeting on gastroscopy's diagnostic value.

Main Methods:

  • A retrospective audit of 1545 consecutive gastroscopies performed between 1986-1988.
  • Patients were categorized into 'clinic' (hospital referral) and 'open access' (general practitioner referral) groups.
  • Data collected included patient demographics, referral source, and endoscopic findings.

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Main Results:

  • Approximately 40% of gastroscopies yielded normal findings in both referral groups.
  • Older patients (>40 years) showed a higher proportion of normal findings in the clinic group (p<0.03).
  • Upper gastrointestinal malignancy was more frequent in hospital-referred patients (5% vs 2%, p<0.005).

Conclusions:

  • Open access gastroscopy is a safe and efficient referral method, not leading to increased unnecessary examinations.
  • Wider availability of open access gastroscopy is recommended.
  • Targeting gastroscopy for patients over 40 could enhance diagnostic yield and reduce requests.