Endoscopy 2003; 35(1): 68-73
DOI: 10.1055/s-2003-36407
Original Article
© Georg Thieme Verlag Stuttgart · New York

Open-Access Endoscopy: Are Age-Based Guidelines Justified? An Audit of Experience of 1000 Open-Access Endoscopies at a District General Hospital

J.  R.  Boulton-Jones1 , M.  C.  Follows1 , A.  A.  Mahmoud1
  • 1Kingsmill Hospital, Sutton-in-Ashfield, UK
Weitere Informationen

Publikationsverlauf

Submitted: 23 November 2001

Accepted after Revision: 5 September 2002

Publikationsdatum:
02. Januar 2003 (online)

Background and Study Aims: Open-access endoscopy has been developed to meet the increasing demand for endoscopy, and guidelines have been produced for selecting suitable patients. This study was designed to assess the appropriateness of these guidelines in patients referred to open-access endoscopy services at a district general hospital.
Patients and Methods: A series of 1000 consecutive patients referred for open-access endoscopy was audited. The waiting time was 18 weeks and patients continued to take any acid-suppressing medication prescribed by their general practitioner. The endoscopy findings were compared in those who met and did not meet currently accepted guidelines. In addition the outcome for all patients in whom gastro-oesophageal malignancy was detected was reviewed.

Results: 301 patients (30.1 %) did not meet accepted guidelines for open-access endoscopy. No cases of malignancy would have been missed if the guidelines had been implemented. Gastro- oesophageal malignancy was detected in 17 patients, all of whom died. When malignancy was excluded, there were no statistically significant differences between the detection rates for pathology in the two groups. The commonest finding, in 32.3 % of patients, was of a normal endoscopic appearance.
Conclusions: If current guidelines are applied, all cases of malignancy may be picked up, but identification of patients with curable disease is poor. Use of the guidelines did not select patients with other upper gastrointestinal disease, although many patients were receiving acid-suppression therapy at the time of their endoscopy. Implementation of test-and-treat strategies would result in a significant reduction in the workload of open-access endoscopy.

References

  • 1 Jones R, Lydeard S. Dyspepsia in the community: a follow-up study.  Br J Clin Pract. 1992;  46 95-97
  • 2 Working Party of the Clinical Services Committee of the British Society of Gastroenterology. Provision of gastrointestinal endoscopy and related services for a district general hospital.  Gut. 1991;  32 95-105
  • 3 Asante M A, Mendall M A, Bland J M, Northfield T C. Determinants of prescribing costs for ulcer-healing drugs and upper gastrointestinal endoscopy in general practice.  Eur J Gastroenterol Hepatol. 1998;  10 589-593
  • 4 Silcock J G, Bramble M G. Open access endoscopy: second survey of current practice in the United Kingdom.  Gut. 1997;  40 192-195
  • 5 Breslin N P, Thomson A BR, Bailey R J. et al . Gastric cancer and other endoscopic diagnoses in patients with benign dyspepsia.  Gut. 2000;  46 93-97
  • 6 Christie J, Shepard N A, Codling B W, Valori R M. Gastric cancer below the age of 55: implications for screening patients with uncomplicated dyspepsia.  Gut. 1997;  41 513-517
  • 7 Patel P, Khulusi M A, Lloyd R. et al . Prospective screening of dyspeptic patients by Helicobacter pylori serology.  Lancet. 1995;  346 1315-1318
  • 8 Vyas S K, Sharpstone D, Treasure J. et al . Pre-endoscopy screening using serodiagnosis of Helicobacter pylori infection.  Eur J Gastroenterol Hepatol. 1994;  6 783-785
  • 9 British Society of Gastroenterology. Dyspepsia management guidelines. Guidelines in gastroenterology. London; British Society of Gastroenterology 1996
  • 10 Talley N J, Axon A, Bytzer P. et al . Management of uninvestigated and functional dyspepsia: a working party report for the World Congress of Gastroenterology 1998.  Aliment Pharmacol Ther. 1998;  13 1135-1148
  • 11 Bytzer P, Hansen J M, Schaffalitzky de Muckadell O B. Empirical H2-blocker therapy or prompt endoscopy in management of dyspepsia.  Lancet. 1994;  343 811-816
  • 12 Hungin A PS, Thomas P R, Bramble M G. et al . What happens to patients following open access endoscopy? An outcome study from general practice.  Br J Gen Pract. 1994;  44 519-521
  • 13 Gear M WL, Wilkinson S P. Open access alimentary endoscopy.  Br J Hosp Med. 1989;  41 438-444
  • 14 Bramble M G, Cooke W M, Corbett W A. et al . Organising unrestricted open access in South Tees.  Gut. 1993;  34 422-427
  • 15 Bodger K, Eastwood P G, Mannings S I. et al . Dyspepsia workload in urban general practice and implications of the British Society of Gastroenterology Dyspepsia Guidelines (1996).  Aliment Pharmacol Ther. 2000;  14 413-420
  • 16 Manes G, Balzano A, Marone P. et al . Appropriateness and diagnostic yield of upper gastrointestinal endoscopy in an open-access endoscopy system: a prospective observational study based on the Maastricht guidelines.  Aliment Pharmacol Ther. 2002;  16 105-110
  • 17 Harvey R F, Spence R W, Lane A J. et al . Relationship between changing patterns of Helicobacter pylori-related duodenal ulcer over 20 years and H. pylori infection rates in the local community: The Bristol Helicobacter Project.  Gastroenterology. 2001;  120 A240
  • 18 Talley N J, Weaver A L, Tesmer D L, Zinsmeister A R. Lack of discriminant value of dyspepsia subgroups in patients referred for upper endoscopy.  Gastroenterology. 1993;  105 1378-1386
  • 19 Thompson W G. Dyspepsia: is a trial of therapy appropriate?.  Can Med Assoc J. 1995;  153 293-299
  • 20 Hansen J M, Bytzer P, Bondesen S, Schaffalitzky de Muckadell O B. Efficacy and outcome of an open access endoscopy service.  Dan Med Bull. 1991;  38 288-290
  • 21 Johannessen T, Peterson H, Kleveland P M. The predictive value of history in dyspepsia.  Scand J Gastroenterol. 1990;  25 689-697
  • 22 Moayyedi P, Zilles A, Clough M. et al . The effectiveness of screening and treating Helicobacter pylori in the management of dyspepsia.  Eur J Gastroenterol Hepatol. 1999;  11 1245-1250
  • 23 Bowie P E, Cox R A, Davidson A R, Steel A. Young dyspeptic patients: with a test-and-treat policy: are the benefits of decreased symptom severity and oesophago-gastric-duodenoscopy workload sustained?.  Eur J Gastroenterol Hepatol. 2001;  13 541-545
  • 24 Collins J SA, Bamford K B, Sloan J M. et al . Screening for Helicobacter pylori antibody could reduce endoscopy workload in young dyspeptic patients.  Eur J Gastroenterol Hepatol. 1992;  4 991-993
  • 25 McColl K EL, Murray L S, Gillen D. et al . Randomised trial of endoscopy with testing for Helicobacter pylori compared with non-invasive H. pylori testing alone in the management of dyspepsia.  BMJ. 2002;  324 999-1002
  • 26 Delaney B C, Wilson S, Roalfe A. et al . Cost effectiveness of initial endoscopy for dyspepsia in patients over age 50 years: a randomised controlled trial in primary care.  Lancet. 2000;  356 1965-1969
  • 27 Delaney B C, Wilson S, Roalfe A. et al . Randomised controlled trial of Helicobacter pylori testing and endoscopy in primary care.  BMJ. 2001;  322 898-901
  • 28 Sue-Ling H M, Johnstone D, Martin I G. et al . Gastric cancer: a curable disease in Britain.  BMJ. 1993;  307 591-596
  • 29 Suvakovic Z, Bramble M G, Jones R. et al . Improving the detection rate of early gastric cancer requires more than open access gastroscopy: a five year study.  Gut. 1997;  41 308-313
  • 30 Haugstvedt T K, Viste A, Eide G E, Soreide O. Patient and physician treatment delay in patients with stomach cancer in Norway: is it important? The Norway Stomach Cancer Trial.  Scand J Gastroenterol. 1991;  26 611-619
  • 31 Martin I G, Young S, Sue-Ling H, Johnstone D. Delays in the diagnosis of oesophagogastric carcinoma: a consecutive case series.  BMJ. 1997;  314 467-470
  • 32 Kiesslich R, Hahn M, Herrmann G, Jung M. Screening for specialized columnar epithelium with methylene blue chromoendoscopy in patients with Barrett’s oesophagus and a normal control group.  Gastrointest Endosc. 2001;  53 47-52
  • 33 Dave U, Shousha S, Westaby D. Methylene blue staining: is it really useful in Barrett’s oesophagus.  Gastrointest Endosc. 2001;  53 333-335

J. R. Boulton-Jones, M.D.

Kingsmill Hospital

1 Lees Road, Mapperley · Nottingham NG3 6HB · United Kingdom

Fax: + 44-115-8405821

eMail: robandalathome@hotmail.com