EVALUATION OF THE CLINICAL IMPACT OF ENDOSCOPIC ULTRASONOGRAPHY IN GASTROINTESTINAL-DISEASE

Background: Outcome studies evaluating the impact of endosonography on patient management are lacking. We conducted a prospective study to a ssess the overall clinical effectiveness of endosonography as perceive d by the requesting physician. Methods: Physicians requesting endosono graphy were asked to fill out a questionnaire listing clinical diagnos is, diagnostic certainty, and future management plans. After the proce dure, the requesting physicians were asked about changes in diagnosis and management, and the physicians' impressions of how clinically help ful the test was. Comparisons were made between the preprocedure and p ostprocedure assessment and plans, changes in diagnosis, diagnostic ce rtainty, patient management plans, and if endosonography led to a more or less invasive course of therapy. Results: Sixty-three patients (35 women and 28 men) were evaluated. Management was altered in 30 patien ts (48%). In 66% of these patients the subsequent course of therapy wa s less invasive. Diagnostic certainty increased from 2.8 before endoso nography to 4.3 after sonography (p = 0.0001). Endosonography was judg ed to be 4.1 on a ''usefulness'' score of 1 to 5. Conclusions: Endoson ography is helpful in improving diagnostic certainty, frequently leadi ng to altered patient management, and is perceived to be a helpful tes t by requesting physicians.