[Guidelines for the rational use of endoscopy to improve the detection of relevant lesions in an open-access endoscopy unit: a prospective study].

BACKGROUND AND
OBJECTIVE: Almost 50% of gastrointestinal endoscopies performed in our Unit correspond to patients coming from primary care. Since resources are finite, adherence to appropriate indications for these procedures is essential. We prospectively assessed the appropriateness of gastrointestinal endoscopies referred from Primary Care according to the European Panel on the Appropriateness of Gastrointestinal Endoscopy (EPAGE) criteria. PATIENTS AND
METHOD: From May to June 2005, all consecutive patients referred from Primary care to our unit for open-access endoscopy were included (478 colonoscopies and 264 gastroscopies). Appropriateness of each exploration was established according to the EPAGE criteria. In order to evaluate whether appropriateness of use correlated with the diagnostic yield of endoscopies, relevant endoscopic findings were recorded.
RESULTS: In 146 patients (20%), an endoscopy indication was not listed in the EPAGE guidelines or data were incomplete and they were not evaluated. In the remaining 596 patients, the indication of the procedure was considered appropriate in 401 (67%) patients (253 [69%], colonoscopies and 148 [65%], gastroscopies). The diagnostic yield was significantly higher for appropriate endoscopies (30% vs 7%, p < 0.001). Endoscopies were more appropriate in older patients and in non-foreigners.
CONCLUSIONS: The diagnostic yield of gastrointestinal endoscopies in patients coming from primary Care increases with the appropriateness of indications according to the EPAGE criteria. Since a noteworthy proportion of these patients' endoscopies are considered inappropriate, the implementation of validated guidelines for its appropriate use could improve this situation.