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. 2022 Aug 31;93(4):e2022210.
doi: 10.23750/abm.v93i4.12772.

A non-invasive combined strategy to improve the appropriateness of upper gastrointestinal endoscopy

Kryssia Rodriguez  1 , Marilisa Franceschi  2 , Antonio Ferronato  3 , Lorenzo Brozzi  4 , Antonio Antico  5 , Maria Piera Panozzo  6 , Arianna Massella  7 , Barbara Pertoldi  8 , Alice Morini  9 , Alberto Barchi  10 , Michele Russo  11 , Pellegrino Crafa  12 , Lorella Franzoni  13 , Lucio Cuoco  14 , Gianluca Baldassarre  15 , Francesco Di Mario  16
Affiliations

A non-invasive combined strategy to improve the appropriateness of upper gastrointestinal endoscopy

Kryssia Rodriguez et al. Acta Biomed. .

Abstract

Background and aim Increasing the appropriateness of upper gastrointestinal endoscopy (UGIE) improves the quality of care while containing costs. The aim of this study was to improve the appropriateness of UGIE through a process involving evaluation of prescriptions and the use of a non-invasive alternative. Materials and methods A senior endoscopist evaluated the appropriateness of all outpatient referrals for UGIE and established the proper timing. Referrals were either accepted and programmed, canceled, or substituted by a non-invasive evaluation of gastric function, determining serum levels of gastrin-17 (G17), Pepsinogen I (PGI) and II (PGII), and antibodies against Helicobacter pylori. Results A total of 5102 requests for UGIE examinations were evaluated; 540 (10.4%) were inappropriate and had been prescribed for: gastroesophageal reflux disease (n=307), surveillance with erroneous timing (n=113), dyspepsia (n=66), other indications (n=20), and absence of written indication (n=34). Gastric function was evaluated in 282/540 patients; findings included normal values in 94 patients without proton-pump inhibitor therapy (PPI) and in 48 on PPI, active H pylori infection in 56, previous H pylori infection in 30, GERD in n=50, and atrophic gastritis in n=4. UGIE was performed in the latter 4 cases. Within 2 years (range 1-22 months) of the initial refusal, 105/504 patients underwent UGIE, with normal endoscopic findings in 71/105 (67.5%), and with no cases of cancer. Conclusions This strategy, based on a strict control of prescriptions, is effective to increase the appropriateness while containing public health costs. The use of gastric function testing improves patient selection for UGIE endoscopy.

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Conflict of interest statement

Each author declares that he or she has no commercial associations (e.g. consultancies, stock ownership, equity interest, patent/licensing arrangement etc.) that might pose a conflict of interest in connection with the submitted article

Figures

Figure 1.
Figure 1.
Volume of yearly upper gastrointestinal endoscopies performed at ULSS 7 Pedemontana Endoscopy Unit during the year before (2012) and the three years following the introduction of gastric function testing (2013-2015). UGIE, upper gastrointestinal endoscopies.
See this image and copyright information in PMC

References

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