Appropriateness of Endoscopic Procedures: A Prospective, Multicenter Study

Area of Science:

• Gastroenterology
• Medical Procedure Appropriateness
• Health Services Research

Background:

• Increased use of endoscopy and open-access systems has led to concerns about overuse.
• Assessing the appropriateness of endoscopic referrals is vital for resource optimization and patient care.
• Disparities in referral appropriateness may exist between public and private healthcare settings.

Purpose of the Study:

• To evaluate the appropriateness of esophagogastroduodenoscopy (EGD) and colonoscopy referrals.
• To compare referral appropriateness between private and public endoscopy units.
• To determine the impact of referral appropriateness on diagnostic yield.

Main Methods:

• Prospective, multicenter study involving 2 public and 5 private endoscopy units.
• Enrollment of patients undergoing elective EGD or colonoscopy, with data collection on clinical information and findings.
• Application of established guidelines (ASGE for EGD, EPAGE II for colonoscopy) to define appropriateness.

Main Results:

• Lower appropriateness rates for EGD (42.4% private vs. 79.3% public) and colonoscopy (53.0% private vs. 88.4% public) were observed in private settings.
• Gastroenterologist referrals showed higher appropriateness for EGD (74.7%) compared to other specialties (56.1%).
• Appropriate indications for colonoscopy were associated with a higher diagnostic yield (63.2% vs. 43.0%).

Conclusions:

• A significant proportion of endoscopies, especially in private facilities, are performed without appropriate indications.
• Indication appropriateness influences the diagnostic yield of endoscopic procedures.
• Implementing and adhering to standardized criteria is essential for the judicious utilization of endoscopy.