Evaluating the clinical efficacy and cost effectiveness of direct access endoscopy

Broe, M.; Barry, Mary; Patchett, Stephen; Hill, Arnold D.

doi:10.1016/j.surge.2013.02.005

Cited by 14 publications

(20 citation statements)

References 18 publications

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“…Nine studies reported the appropriateness of test requests using guidelines from the American Society for Gastrointestinal Endoscopy, 24,58,76,77 the European Panel of the Appropriateness of Gastrointestinal Endoscopy, 51,55 the British Society of Gastroenterology, 25 NICE, 26 and previously published work. 28 Overall, there was no significant difference between the appropriateness of GP DA referrals (mean pooled appropriateness 66.4%, 95% CI = 41.2 to 87.4%) and specialist referrals (mean pooled appropriateness 80.9%, 95% CI = 73.9 to 87.1%) (P = 0.24).…”

Section: Appropriateness Of Referralmentioning

confidence: 99%

Direct access cancer testing in primary care: a systematic review of use and clinical outcomes

et al. 2018

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Section: Appropriateness Of Referralmentioning

confidence: 99%

Direct access cancer testing in primary care: a systematic review of use and clinical outcomes

et al. 2018

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“…Most studies of the diagnostic yields of OAE used American or British guidelines to examine the appropriateness of the OAE indication. These guidelines contain more indications than the Dutch College of General Practitioner guideline (NHG guideline) “upper abdominal complaints” 5 6 7 8 . The performed studies about the yield of OAE showed widely ranging non-adherence rates and also different rates of clinical relevant findings 3 4 8 9 10 .…”

Section: Introductionmentioning

confidence: 99%

The diagnostic yield of open-access endoscopy of the upper gastrointestinal tract in the Netherlands

Crouwel¹,

Meurs-Szojda²,

Klemt-Kropp³

et al. 2018

Endosc Int Open

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Background and study aims Since the introduction of open-access esophago-gastroduodenoscopy (OAE) there is an increase in the total number of performed OAEs whilst the frequency of clinical relevant findings has decreased. The aim of this study was to assess the appropriate use and the diagnostic yield of OAE in the Netherlands and to determine which patient variables are able to predict a malignant finding. Patients and methods A retrospective chart review of all referrals for diagnostic OAE between October 2012 and October 2016 at the Northwest Clinics was performed. The indications were recorded from the referral letter and were classified as “appropriate” or “inappropriate” according to the NHG guideline. Logistic regression was used to detect significant predictive variables for a malignancy. Results A total of 2006 patients were included, of whom 59.6 % had an ‘appropriate’ referral indication. The diagnostic yield of finding a clinical relevant finding was significantly higher for OAEs with an “appropriate” referral indication. Independent risk factors for malignancy were alarm symptoms, age and male gender with a combined AUC of 0.868. Conclusions Only 3.8 % of the malignancies would be missed by strict adherence to the guideline. This indicates that the open-access system in the Netherlands works well. Further improvement of the system can be achieved by only accepting appropriate indications for OAE and by treating patients under the age of 40 without OAE. We showed that a risk-prediction model based on the variables age, alarm symptoms and male gender is a good predictor of malignant finding.

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“…Direct access endoscopy (DAE) is a diagnostic procedure that allows hospital medicine physicians (hospitalists) to refer patients to inpatient endoscopy without prior evaluation by a gastroenterologist (GI). DAE was initially introduced to allow primary care physicians to quickly refer patients for endoscopic evaluation when they presented with gastrointestinal symptoms, thereby reducing cost and wait time for patients [1]. Although DAE is widely available in outpatient settings, this study is the first to explore the effectiveness of DAE in an inpatient setting in the United States.…”

Section: Introductionmentioning

confidence: 99%

Appropriateness and Safety of Direct Access Endoscopy in Hospitalized Patients

D'Souza

Almuhaidb

Early

et al. 2020

Cureus

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Evaluating the clinical efficacy and cost effectiveness of direct access endoscopy

Cited by 14 publications

References 18 publications

Direct access cancer testing in primary care: a systematic review of use and clinical outcomes

Direct access cancer testing in primary care: a systematic review of use and clinical outcomes

The diagnostic yield of open-access endoscopy of the upper gastrointestinal tract in the Netherlands

Appropriateness and Safety of Direct Access Endoscopy in Hospitalized Patients

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