OPEN-ACCESS ENDOSCOPY OF THE UPPER GASTROINTESTINAL-TRACT - IS IT INDICATED AND EFFICIENT - RETROSPECTIVE AND PROSPECTIVE STUDIES IN AN ISRAELI POPULATION
R. Oren et al., OPEN-ACCESS ENDOSCOPY OF THE UPPER GASTROINTESTINAL-TRACT - IS IT INDICATED AND EFFICIENT - RETROSPECTIVE AND PROSPECTIVE STUDIES IN AN ISRAELI POPULATION, Israel journal of medical sciences, 33(12), 1997, pp. 771-776
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.