BACKGROUND: Open-access endoscopy allows physicians to directly schedule endoscopic procedures for their patients without prior consultation. Evaluation of both appropriateness and diagnostic yield of endoscopic procedures is critical when assessing the costs and benefits of endoscopy in an open-access setting. The aim of this study was to assess the appropriate use of colonoscopy in an open-access system and to establish the yield of diagnostic information relevant to patient care. METHODS: Overall, 1123 consecutive patients referred for open-access colonoscopy were prospectively enrolled in the study. The American Society for Gastrointestinal Endoscopy (ASGE) guidelines were used to assess the relationship between the appropriate use of colonoscopy and the presence of relevant endoscopic findings. RESULTS: The rate of colonoscopies "generally not indicated" according to ASGE guidelines was 29% (39% for primary care physicians and 23% for specialists; p < 0.0001). A relevant endoscopic finding was detected in 338 examinations (35%). The diagnostic yield was significantly higher for "generally indicated" colonoscopies (43%) compared with "generally not indicated" procedures (16%) (p < 0.001). CONCLUSIONS: Although the rate of inappropriate use of colonoscopy was high, open-access colonoscopy was effective in detecting neoplastic lesions. Because most of these were detected during examinations performed for appropriate indications, the appropriateness of the indication emerges as crucial to the cost-effectiveness of an open-access system.
BACKGROUND: Open-access endoscopy allows physicians to directly schedule endoscopic procedures for their patients without prior consultation. Evaluation of both appropriateness and diagnostic yield of endoscopic procedures is critical when assessing the costs and benefits of endoscopy in an open-access setting. The aim of this study was to assess the appropriate use of colonoscopy in an open-access system and to establish the yield of diagnostic information relevant to patient care. METHODS: Overall, 1123 consecutive patients referred for open-access colonoscopy were prospectively enrolled in the study. The American Society for Gastrointestinal Endoscopy (ASGE) guidelines were used to assess the relationship between the appropriate use of colonoscopy and the presence of relevant endoscopic findings. RESULTS: The rate of colonoscopies "generally not indicated" according to ASGE guidelines was 29% (39% for primary care physicians and 23% for specialists; p < 0.0001). A relevant endoscopic finding was detected in 338 examinations (35%). The diagnostic yield was significantly higher for "generally indicated" colonoscopies (43%) compared with "generally not indicated" procedures (16%) (p < 0.001). CONCLUSIONS: Although the rate of inappropriate use of colonoscopy was high, open-access colonoscopy was effective in detecting neoplastic lesions. Because most of these were detected during examinations performed for appropriate indications, the appropriateness of the indication emerges as crucial to the cost-effectiveness of an open-access system.
Authors: David Armstrong; Alan Barkun; Ron Bridges; Rose Carter; Chris de Gara; Catherine Dube; Robert Enns; Roger Hollingworth; Donald Macintosh; Mark Borgaonkar; Sylviane Forget; Grigorios Leontiadis; Jonathan Meddings; Peter Cotton; Ernst J Kuipers Journal: Can J Gastroenterol Date: 2012-01 Impact factor: 3.522
Authors: João Mangualde; Marie I Cremers; Ana M Vieira; Ricardo Freire; Elia Gamito; Cristina Lobato; Ana L Alves; Fátima Augusto; Ana P Oliveira Journal: World J Gastrointest Endosc Date: 2011-10-16
Authors: Douglas K Rex; Philip S Schoenfeld; Jonathan Cohen; Irving M Pike; Douglas G Adler; M Brian Fennerty; John G Lieb; Walter G Park; Maged K Rizk; Mandeep S Sawhney; Nicholas J Shaheen; Sachin Wani; David S Weinberg Journal: Am J Gastroenterol Date: 2014-12-02 Impact factor: 10.864
Authors: A Z Gimeno García; Y González; E Quintero; D Nicolás-Pérez; Z Adrián; R Romero; O Alarcón Fernández; M Hernández; M Carrillo; V Felipe; J Díaz; L Ramos; M Moreno; A Jiménez-Sosa Journal: Endoscopy Date: 2011-11-22 Impact factor: 10.093
Authors: Barbara-Ann Adelstein; Petra Macaskill; Siew F Chan; Peter H Katelaris; Les Irwig Journal: BMC Gastroenterol Date: 2011-05-30 Impact factor: 3.067