OPEN-ACCESS ENDOSCOPY OF THE UPPER GASTROINTESTINAL-TRACT - IS IT INDICATED AND EFFICIENT - RETROSPECTIVE AND PROSPECTIVE STUDIES IN AN ISRAELI POPULATION

Open-access endoscopy has recently gained popularity in referring pati ents for endoscopic procedures. Retrospective (looking into patients' medical files) and prospective studies (using 2 different questionnair es, and evaluating a selection system) were conducted, comparing the e fficacy of open-access endoscopy for patients referred by either famil y practitioners or gastroenterologists. In the retrospective study, 67 3 patients (mean age 48.8 years, male -58%) underwent upper gastrointe stinal endoscopy. The main indications for upper endoscopy were epigas tric pain (71%), heartburn (18%) and vomiting (13%), Severe endoscopic findings were not different between the study groups. Normal or mildl y abnormal findings were diagnosed in 75% of patients in both groups. In the prospective study, 361 patients were referred for upper endosco py (mean age 50.2 years, male -58%). Although there were significantly (p<0.01) fewer normal and more mild endoscopic findings in the patien ts referred by gastroenterologists, as compared with family practition ers, there was no difference in the clinically significant (severe) en doscopic findings, Previous ulcer, smoking, gender, age and nocturnal pain were predictive for severe endoscopic findings. There was a linea r correlation between the severity of the scoring system and the endos copic findings. The results of the present study, which reveal nonsign ificant differences in the indications for and the findings of endosco pies, indicate that selection of patients for endoscopy can be safely done by family practitioners, In order to reduce the number of referre d patients with no gastrointestinal pathology, a better scoring system to detect at-risk patients should be developed.