Endoscopy 2020; 52(S 01): S184
DOI: 10.1055/s-0040-1704574
ESGE Days 2020 ePoster Podium presentations
Friday, April 24, 2020 14:30 – 15:00 Upper GI endoscopy ePoster Podium 4
© Georg Thieme Verlag KG Stuttgart · New York

THE GASTROPACK SYSTEM AS A MODEL FOR EGD APPROPRIATENESS IN PATIENTS WITH UPPER GASTROINTESTINAL SYMPTOMS: A COMPARISON WITH THE OPEN ACCESS SYSTEM

L Ceroni
1   AUSL Bologna Bellaria-Maggiore Hospital, Gastroenterology and Inteventional Endoscopy, Bologna, Italy
,
F Lodato
1   AUSL Bologna Bellaria-Maggiore Hospital, Gastroenterology and Inteventional Endoscopy, Bologna, Italy
,
C Fabbri
1   University of Bologna, Engineering, Bologna, Italy
,
P Tubertini
1   AUSL Bologna, Process Reengineering, Bologna, Italy
,
M Biselli
1   Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
,
A Gramenzi
1   Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
,
MT Migliano
1   Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
,
F Ferrara
1   AUSL Bologna Bellaria-Maggiore Hospital, Gastroenterology and Inteventional Endoscopy, Bologna, Italy
,
F Buonfiglioli
1   AUSL Bologna Bellaria-Maggiore Hospital, Gastroenterology and Inteventional Endoscopy, Bologna, Italy
,
R Schiumerini
1   AUSL Bologna Bellaria-Maggiore Hospital, Gastroenterology and Inteventional Endoscopy, Bologna, Italy
,
A Polifemo
1   AUSL Bologna Bellaria-Maggiore Hospital, Gastroenterology and Inteventional Endoscopy, Bologna, Italy
,
A Alberani
1   AUSL Bologna Bellaria-Maggiore Hospital, Gastroenterology and Inteventional Endoscopy, Bologna, Italy
,
A Gazzola
1   AUSL Bologna Bellaria-Maggiore Hospital, Gastroenterology and Inteventional Endoscopy, Bologna, Italy
,
V Cennamo
1   AUSL Bologna Bellaria-Maggiore Hospital, Gastroenterology and Inteventional Endoscopy, Bologna, Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
23 April 2020 (online)

Also available at
 

Aims EGD appropriate use in Open-Access System (OAS) is a relevant issue in Endoscopy due to the significant amount of economic resources and time involved. In Italy, previous data reported a 22.9% rate of inappropriate EGDs according to ASGE guidelines. Inappropriate prescriptions were made more frequently by General Practitioners (GPs)s (29.4%) compared to specialists (12.9%). This study aims to evaluate if the GASTROPACK SYSTEM (GS), a new method to access gastroenterological care, may reduce inappropriate indications to EGD compared to the OAS.

Methods The GS was implemented in a 57.156-inhabitant area of Bologna where GPs could decide to directly prescribe EGD through pre-existing OAS or to refer patients to GS. In GS, diagnostic work-up is scheduled after a preliminary contact between GPs and specialists sharing patient’s clinical information. Prospective data of patients with upper GI symptoms receiving an EGD prescription from GS and OAS were compared.

Results Between May 2016-2019, 2179 cases (39.5% males, median age 61yrs) were referred to GS and 1424 (65%) underwent EGD. Meanwhile, in the same geographical area 874 EGD prescriptions (43.8% males, median age 58yrs) were recorded through OAS. According to ASGE guidelines, EGD indication was appropriate in 92% of cases of GS compared to 79% of OAS (p< 0.01). Strong adherence to ASGE guidelines was observed in the GS population (sensibility 99.4%, specificity 86.2%) with LR+ 7.19 CI 6.99-7.39, LR- 0.007. However, rates of endoscopic findings did not differ when EGD was performed with (49%) or without (46%) an appropriate indication

(p= 0.557, LR+ 1.01 CI 0.79-1.28; LR- 0.88 CI 0.69-1.13).

Conclusions EGD prescriptions through GS present the highest rate of appropriateness ever reported in literature, thus offering a virtuous alternative to the existing OAS. However, adherence to guidelines does not directly improve diagnostic yield due to the low predictive value of ASGE guidelines.