Is the diagnostic yield of upper GI endoscopy improved by the use of explicit panel-based appropriateness criteria?

Background: Increasing the appropriateness of use of upper gastrointestinal (GI) endoscopy is important to improve quality of care while at the same t ime containing costs. This study explored whether detailed explicit appropr iateness criteria significantly improve the diagnostic yield of upper GI en doscopy. Methods: Consecutive patients referred for upper GI endoscopy at 6 centers (1 university hospital, 2 district hospitals, 3 gastroenterology practices) were prospectively included over a 6-month period. After controlling for d isease presentation and patient characteristics, the relationship between t he appropriateness of upper GI endoscopoy, as assessed by explicit Swiss cr iteria developed by the RAND/UCLA panel method, and the presence of relevan t endoscopic lesions was analyzed. Results: A total of 2088 patients (60% outpatients, 57% men) were included. Analysis was restricted to the 1681 patients referred for diagnostic upper GI endoscopy. Forty-six percent of upper GI endoscopies were judged to be appropriate, 15% uncertain, and 39% inappropriate by the explicit criteria. No cancer was found in upper GI endoscopies judged to be inappropriate. Up per GI endoscopies judged appropriate or uncertain yielded significantly mo re relevant lesions (60%) than did those judged to be inappropriate (37%; o dds ratio 2.6: 95% Cl [2.2, 3.2]). in multivariate analyses, the diagnostic yield of upper GI endoscopy was significantly influenced by appropriatenes s, patient gender and age, treatment setting, and symptoms. Conclusions: Upper GI endoscopies performed for appropriate indications res ulted in detecting significantly more clinically relevant lesions than did those performed for inappropriate indications. In addition, no upper GI end oscopy that resulted in a diagnosis of cancer was judged to be inappropriat e. The use of such criteria improves patient selection for upper GI endosco py and can thus contribute to efforts aimed at enhancing the quality and ef ficiency of care.