Do we practice what we preach? Clinical decision making and utilization ofendoscopic ultrasound for staging esophageal cancer

Authors
Citation
Ls. Kim et J. Koch, Do we practice what we preach? Clinical decision making and utilization ofendoscopic ultrasound for staging esophageal cancer, AM J GASTRO, 94(7), 1999, pp. 1847-1852
Citations number
10
Categorie Soggetti
Gastroenerology and Hepatology
Journal title
AMERICAN JOURNAL OF GASTROENTEROLOGY
ISSN journal
00029270 → ACNP
Volume
94
Issue
7
Year of publication
1999
Pages
1847 - 1852
Database
ISI
SICI code
0002-9270(199907)94:7<1847:DWPWWP>2.0.ZU;2-J
Abstract
OBJECTIVES: Endosonography is accurate for staging esophageal cancer. Howev er, whether detailed staging impacts clinical decision making, whether endo sonography is perceived as a useful modality, and what factors influence th e utilization of endosonography have not been studied. METHODS: One hundred gastroenterologists were surveyed about staging and ma nagement of esophageal cancer, including: 1) management by stage; 2) percei ved usefulness of endosonography; 3) availability of endosonography; and 4) number of patients referred. RESULTS: Clinical decisions varied by incremental differences in tumor stag e. However, only 27 of 66 respondents (40.9%) judged endosonography to be v ery useful or essential for the evaluation of esophageal cancer and only 22 (33.3%) had referred a patient. Perceived usefulness and availability were independent factors strongly associated with referral for endosonography. Among 18 respondents to whom endosonography was available and who considere d it useful, 14 (77.9%) had referred a case. In contrast, a conservative ma nagement was not associated with either perceived usefulness of or referral for endosonography. CONCLUSIONS: Clinicians recognize the importance of detailed staging for ma nagement of esophageal cancer. Despite this, they underestimate the utility of endosonography and fail to refer patients for appropriate evaluation. L ack of perceived usefulness and unavailability are important independent ba rriers to utilization of endosonography in clinical practice. (Am J Gastroe nterol 1999;94:1847-1852. (C) 1999 by Am. Coll. of Gastroenterology).