Endoscopists’ Opinions of Indications for Upper Gastrointestinal Endoscopy

Abstract

OBJECTIVE:To determine whether endoscopists and general internists agreed with the characterization of appropriateness for endoscopy of various clinical scenarios, as previously reported by the RAND Corporation. DESIGN: Mail survey. STUDY SAMPLE: All endoscopists in western Canada and a random sample of general internists who did not perform endoscopy. METHODS: Questionnaires were sent to 179 endoscopists in western Canada who were asked to rate the 53 scenarios for endoscopy on a nine-point scale ranging from most appropriate to most inappropriate. A similar questionnaire was sent to 39 general internists practising in the province of Alberta. RESULTS: Response rate was 72% of endoscopists (n=128) and 64% of general internists (n=25). Among the endoscopists, there was agreement with the RAND classification for 32 scenarios. All 18 indications previously thought to be appropriate were considered to be appropriate. However, endoscopists agreed with only six of 16 equivocal and eight of 19 indications considered inappropriate. Discrepancies were reviewed by five experienced endoscopists and most appeared to be related to a concern regarding possible malignancy linked in part with the definition of failure to respond to medical therapy; and to a refusal to request a barium meal before endoscopy. Among general internists, there was agreement with RAND in 26 scenarios. When the appropriateness rankings of endoscopists and general internists were compared, there was agreement in 40 of 53 scenarios. Significant discrepancies in ratings were identified in scenarios in which barium studies were described as being normal, known or not done. CONCLUSIONS:The equivocal and inappropriate ratings developed by the RAND Corporation are not uniformly accepted by the endoscopy community or general internists. Use of the RAND indications for assessing quality assurance can be challenged. Key Words: Endoscopy, Indications, SurveyOpinions des endoscopistes sur les indications de l'endoscopie des voies digestives hautes OBJECTIF : Vérifier si les endoscopistes et les internistes généraux s'entendent sur le bien-fondé de l'endoscopie appliquée à divers scénarios cliniques, comme en faisait état un rapport antérieur de la corporation RAND. MODÈLE : Sondage par la poste. ÉCHANTILLON ÉTUDIÉ : Tous les endoscopistes et un échantillon aléatoire d'internistes généraux de l'Ouest du Canada qui effectuent des endoscopies. MÉTHODES : Les questionnaires ont été envoyés à 179 endoscopistes de l'Ouest du Canada à qui on a demandé de classer 53 scénarios d'endoscopie sur une échelle en neuf points, allant du plus au moins approprié. Un questionnaire semblable a été expédié à 39 internistes généraux de la province de l'Alberta. RÉSULTATS : Le taux de réponse a été de 72 % pour les endoscopistes (n = 128) et de 64 % pour les internistes généraux (n = 25). Parmi les endoscopistes, on a noté une concordance avec la classification de RAND pour 32 scénarios. Les 18 indications auparavant jugées appropriées ont été jugées appropriées. Toutefois, les endos...

Patterns of Use of Flexible Sigmidoscopy, Colonoscopy and Gastroscopy: A Population‐Based Study in a Canadian Province

“…However, there has been growing recognition of the superiority of gastroscopy for the evaluation of upper GI symptoms, both in terms of diagnostic accuracy and patient acceptance (22,23). This is reflected in a Canadian study that demonstrated that endoscopists classified many procedures as appropriate that were classified as equivocal or inappropriate by Chassin et al (21), including the one described above (24). The authors felt the differences between the Rand and Canadian endoscopists' ratings were due to concerns about missing malignancies and a lack of confidence in barium studies.…”