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. 2023 May 8;12(9):3343.
doi: 10.3390/jcm12093343.

The Gastropack Access System as a Model to Access Gastroenterology Services for Gastroscopy Appropriateness in Patients with Upper Gastrointestinal Symptoms: A Comparison with the Open Access System

Liza Ceroni  1 , Francesca Lodato  1 , Paolo Tubertini  2   3 , Giovanni Marasco  4   5 , Alessia Gazzola  1 , Maurizio Biselli  5   6 , Cristiano Fabbri  2   3 , Federica Buonfiglioli  1 , Francesco Ferrara  1 , Ramona Schiumerini  1 , Andrea Fabbri  4   5 , Alessandra Tassoni  7 , Carlo Descovich  8 , Sandra Mondini  9 , Cesare Tosetti  9 , Valerio Veduti  9 , Mario De Negri  9 , Alessandro Fini  9 , Stefano Guicciardi  10   11 , Massimo Romanelli  12 , Giuseppe Giovanni Navarra  13 , Giovanni Barbara  4   5 , Vincenzo Cennamo  1 , On Behalf Of Gastropack System Study Group
Affiliations

The Gastropack Access System as a Model to Access Gastroenterology Services for Gastroscopy Appropriateness in Patients with Upper Gastrointestinal Symptoms: A Comparison with the Open Access System

Liza Ceroni et al. J Clin Med. .

Abstract

Esophagogastroduodenoscopy (EGD) appropriateness in Open-Access System (OAS) is a relevant issue. The Gastropack Access System (GAS) is a new system to access gastroenterological services, based on the partnership between Gastroenterologists and GPs. This study aims to evaluate if GAS is superior to OAS in terms of EGDS appropriateness. Secondarily, we evaluated the diagnostic yield of EGDS according to ASGE guidelines. The GAS was developed in an area of Bologna where General Practitioners (GPs) could decide to directly prescribe EGDS through OAS or referring to GAS, where EGDS can be scheduled after contact between GPs and specialists sharing a patient's clinical information. Between 2016 and 2019, 2179 cases (M:F = 861:1318, median age 61, IQR 47.72) were referred to GAS and 1467 patients (65%) had a prescription for EGDS; conversely, 874 EGDS were prescribed through OAS (M:F = 383:491; median age 58 yrs, IQR 45.68). Indication was appropriate in 92% in GAS (1312/1424) versus 71% in OAS (618/874), p < 0.001. The rate of clinically significant endoscopic findings (CSEF) was significantly higher in GAS (49% vs. 34.8%, p < 0.001). Adherence to ASGE guidelines was not related to CSEF; however, surveillance for pre-malignant conditions was independently related to CSEF. All neoplasm were observed in appropriate EGD. GAS is an innovative method showing extremely high rates of appropriateness. ASGE guidelines confirmed their validity for cancer detection, but their performance for the detection of other conditions needs to be refined.

Keywords: endoscopy; general practice; guidelines; shared medicine.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The GAS organization: GP and gastroenterologist share the patient’s clinical pathway; support staff organizes examinations in the predetermined time frame and merges them into the same day if possible. Once the pathway is concluded, the patient is referred back to the GP.
Figure 2
Figure 2
The OAS organization: The GP prescribes one or more services that are scheduled on different days and places according to the assigned priority and availability; after performing each test, the patient returns to the GP to show the result, and he can ask for further investigations.
Figure 3
Figure 3
Flowchart of the study populations.
Figure 4
Figure 4
Difference in CSEF rate according to group (GAS vs. OAS) and appropriateness of EGDS.
See this image and copyright information in PMC

References

    1. ASGE Standards of Practice Committee. Chandrasekhara V., Eloubeidi M.A., Bruining D.H., Chathadi K., Faulx A.L., Fonkalsrud L., Khashab M.A., Lightdale J.R., Muthusamy V.R., et al. Open-access endoscopy. Gastrointest. Endosc. 2015;81:1326–1329. doi: 10.1016/j.gie.2015.03.1917. - DOI - PubMed
    1. Pike I.M. Open-access endoscopy. Gastrointest. Endosc. Clin. N. Am. 2006;16:709–717. doi: 10.1016/j.giec.2006.08.012. - DOI - PubMed
    1. Keren D., Rainis T., Stermer E., Lavy A. A nine-year audit of open-access upper gastrointestinal endoscopic procedures: Results and experience of a single centre. Can. J. Gastroenterol. 2011;25:83–88. doi: 10.1155/2011/379014. - DOI - PMC - PubMed
    1. Caselli M., Parente F., Palli D., Covacci A., Alvisi V., Gasbarrini G., Porro G.B., Cervia Working Group “Cervia Working Group Report”: Guidelines on the diagnosis and treatment of Helicobacter pylori infection. Dig. Liver Dis. 2001;33:75–80. doi: 10.1016/S1590-8658(01)80139-0. - DOI - PubMed
    1. ASGE Standards of Practice Committee. Early D.S., Ben-Menachem T., Decker G.A., Evans J.A., Fanelli R.D., Fisher D.A., Fukami N., Hwang J.H., Jain R., et al. Appropriate use of GI endoscopy. Gastrointest. Endosc. 2012;75:1127–1131. doi: 10.1016/j.gie.2012.01.011. - DOI - PubMed

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