Value of gastroscopy without a prior consultation.

Upper endoscopy is the most accurate and cost effective tool available to physicians when confronted with a patient with dyspepsia. Access to this procedure in Canada is generally limited by the requirement to see a consultant physician before the procedure can be performed. This review, in a question and answer style, builds a case for the introduction of open access endoscopy in Canada. Endoscopy is an effective and valid diagnostic test. Consultants are no better at deciding who requires endoscopy than general practitioners. Clinical patterns of dyspepsia are not a valid guideline for appropriate use of endoscopy. There is value in a normal endoscopy in terms of changes to medical treatment, reassurance, lower consultation and medical clinic attendance rates--and radiation exposure is avoided. After endoscopy, normal patients tend to make 41% fewer physician visits, prescriptions decrease by 71%, and 66% feel better and are more productive at work. Open access endoscopy is cost effective, even when American costs are used. Open access endoscopy should not overrun endoscopy suites if we use the British experience as a guide. The endoscopist would only require a limited history and physical examination to determine safety of the procedure. Follow-up and management is the responsibility of the referring physician, and this must be communicated to the patient and referring physician. The Canadian Association of Gastroenterology needs to draw up guidelines along with the Canadian Medical Practitioners Association for the adoption of this practice.