Appropriateness of outpatient gastrointestinal endoscopy in a non-academic hospital

Table 1 Demographic and clinical characteristics of the study population

	EGD	Colonoscopy
Sex (M/F)	191/190	218/190
Age (mean ± SD, yr)	59.5 ± 15	61.4 ± 13.0
Age (< 45 yr/≥ 45 yr, %)	16.8/83.2	11.3/88.7
Clinical setting (elective/urgent)	94.8/5.2	94.4/5.6

EGD: Esophagogastroduodenoscopy.

Table 2 Indications for esophagogastroduodenoscopy and diagnostic yield according to the American Society for Gastrointestinal Endoscopy guidelines n (%)

ASGE Indication	Frequency	Relevant lesions (%)	P
Appropriate indication	315 (82.7)	36.6
Upper abdominal symptoms1	108 (28.3)	21.3	0.001
Esophageal reflux symptoms that are persistent or recurrent despite appropriate therapy	46 (12.1)	39.1	0.412
Portal hypertension evaluation	30 (7.9)	80.0	< 0.0001
Follow-up of gastric ulcer	24 (6.3)	33.3	1.0
Iron deficiency anemia	23 (6.0)	13.0	0.018
Endoscopic treatment	18 (4.7)	77.8	< 0.0001
Dysphagia or odynophagia	16 (4.1)	62.5	0.027
Surveillance for malignancy in patients with Barrett’s esophagus	11 (2.9)	90.9	< 0.0001
Persistent vomiting of unknown cause	11 (2.9)	18.2	0.346
Active or recent GI bleeding	10 (2.6)	30.0	1.0
For confirmation and specific histologic diagnosis of radiologically demonstrated lesions	8 (2.1)	50.0	0.451
Sampling of tissue or fluid	7 (1.8)	14.3	0.236
Others	24 (6.2)	25.0	0.523
Uncertain indication	22 (5.8)	36.4
Anemia not otherwise characterized	22 (5.8)	36.4	1.0
Inappropriate indication	44 (11.5)	11.4
Surveillance for malignancy in patients with chronic gastritis	11 (2.9)	0	< 0.0001
Surveillance for malignancy in patients with prior gastric operation	10 (2.6)	25.0	0.758
Follow-up of duodenal ulcer	8 (2.1)	30.0	1.0
Others	15 (3.8)	0	< 0.0001

¹Upper abdominal symptoms persistent, despite therapy, associated with symptoms or signs suggesting serious organic disease or occurring in patients > 45 years old. ASGE: American Society for Gastrointestinal Endoscopy; GI: Gastrointestinal.

Table 3 Clinically relevant endoscopic findings in esophagogastroduodenoscopies according to appropriateness of the indication

Endoscopic finding	n (%)	ASGE (%)	Uncertain (%)	Non-ASGE (%)	P
Esophageal varices	30 (7.9)	8.9	9.1	0.0	0.119
Erosive esophagitis	27 (7.1)	7.6	4.5	4.5	0.676
Gastric ulcer	21 (5.5)	6.7	0.0	0.0	0.097
Gastric polyps	16 (4.2)	4.1	13.6	0.0	0.033
Barrett’s esophagus	17 (4.5)	4.8	0.0	4.5	0.578
Duodenal ulcer	10 (2.6)	2.2	9.1	2.3	0.148
Gastric cancer	9 (2.4)	2.9	0.0	0.0	0.038
Candida esophagitis	5 (1.3)	1.6	0.0	0.0	0.475
Angiodysplasia1	2 (0.5)	0.6	0.0	0.0	0.856
Esophageal cancer	1 (0.3)	0.3	0.0	0.0	0.900
Esophageal stenosis	1 (0.3)	0.3	0.0	0.0	0.900
Gastric stenosis	1 (0.3)	0.3	0.0	0.0	0.900
Total	129 (33.9)	36.6	36.4	11.4	0.004

¹Only angiodysplasias found in exams performed for hematochezia or iron deficiency anemia were considered clinically relevant. ASGE: American Society for Gastrointestinal Endoscopy.

Table 4 Indications for colonoscopy and diagnostic yield according to the American Society for Gastrointestinal Endoscopy guidelines n (%)

ASGE Indication	Frequency	Relevant lesions (%)	P
Appropriate indication	337 (82.6)	24.3
Follow-up of colonic polyps	79 (19.4)	21.5	0.879
Excision of colonic polyp	71 (17.4)	42.3	< 0.0001
Screening for colonic neoplasia	52 (12.7)	7.7	0.010
Hematochezia	36 (8.8)	30.6	0.197
Follow-up for colorectal cancer	31 (7.6)	9.7	0.166
Diarrhea	30 (7.4)	16.7	0.647
Iron deficiency anemia	20 (4.9)	5.0	0.090
Follow-up for inflammatory bowel disease	12 (2.9)	100	< 0.0001
Evaluation of an imaging study abnormality that is likely to be clinically significant	10 (2.5)	0.0	0.129
Presence of fecal occult blood	9 (2.2)	44.4	0.098
Evaluation for synchronous cancer or neoplastic polyps	4 (1.0)	100	0.002
Uncertain indication	10 (2.4)	20.0
Anemia not otherwise characterized	10 (2.4)	20.0	1.000
Inappropriate indication	61 (15.0)	3.3
Abdominal pain	50 (12.3)	6.0	0.005
Chronic constipation	18 (4.4)	5.5	0.006
Unexplained weight loss	6 (1.5)	0.0	< 0.0001
Others	14 (3.4)	0.0	< 0.0001

ASGE: American Society for Gastrointestinal Endoscopy.

Table 5 Clinically relevant endoscopic findings in colonoscopies according to appropriateness of the indication

Endoscopic finding	n (%)	ASGE (%)	Uncertain (%)	Non-ASGE (%)	P
Adenoma1	69 (13.2)	15.7	0.0	1.6	0.005
Colorectal cancer	15 (3.7)	3.6	20.0	1.6	0.755
Inflammatory bowel disease	12 (2.9)	3.6	0.0	0.0	0.272
Angiodysplasia2	2 (0.5)	0.6	0.0	0.0	1.000
Radiation colitis	3 (0.7)	1.0	0.0	0.0	1.000
Total	86 (21.1)	24.3	20.0	3.3	0.001

¹Only malignant or advanced adenomas were considered clinically relevant;

²Only angiodysplasias found in exams performed for hematochezia or iron deficiency anemia were considered clinically relevant. ASGE: American Society for Gastrointestinal Endoscopy.