GuidelineOpen-access endoscopy
Section snippets
Appropriateness of referral
Several studies have evaluated the appropriateness of referrals to endoscopy in an OAE system. Most authors have used the ASGE guideline entitled “Appropriate Use of GI Endoscopy” to determine appropriate referrals.6 The reported rate of EGD or colonoscopy procedures performed for “generally not indicated” or unlisted indications worldwide ranged from 5% to 49%.8, 9, 10, 11, 12, 13, 14, 15 Most studies have found a significantly higher rate of inappropriate referrals by nongastroenterologists
Patient acceptance for preparedness for OAE
Patients referred for OAE should receive adequate preprocedure instructions. This education improves patient compliance with and tolerance of the procedure and contributes to a successful endoscopy procedure.22, 23 Several studies have demonstrated the OAE model to be acceptable to patients, with no differences in understanding or patient satisfaction compared with individuals with previous office consultation.24, 25, 26 In addition, there appear to be no differences in the rates of
Periprocedural education and informed consent for OAE
Many endoscopists provide preprocedure education during an office visit before the scheduled procedure. The OAE model, however, does not readily permit this education to occur before the day of the procedure. Informed consent on the day of the OAE procedure is acceptable. However, 1 study showed that OAE patients are more likely not to be able to identify the planned procedure compared with patients scheduled through a GI clinic (24% vs 15%; P < .01) at the time of check-in for their procedure.
Diagnostic yield
Several studies have clearly shown that appropriate OAE referrals based on ASGE guidelines result in higher diagnostic yields of clinically relevant findings.5, 13, 15, 16 A prospective, multicenter Italian study of 6270 patients noted a significantly higher diagnostic yield for appropriate upper endoscopies (52% vs 29%; odds ratio 2.65; 99% confidence interval, 2.23-3.20).13 In this study, 132 upper GI malignancies were diagnosed in appropriate OAE referrals compared with only 1 malignancy on
Follow-up
After the OAE procedure, results of the examination, histopathologic analysis, and subsequent management recommendations should be communicated to the patient and the referring provider. A study of 168 patients undergoing open-access upper endoscopy and colonoscopy noted high rates of documented compliance with diagnostic (75%) and therapeutic (90%) recommendations.12 In this study, there was little need for continued gastroenterology follow-up because a gastroenterology consultation was
Summary
OAE is commonly used. The majority of patients referred for OAE are considered appropriate for endoscopy according to ASGE guidelines. Most patients undergoing OAE procedures are knowledgeable about the study and are satisfied with the experience. Several potential problems have been identified, including inappropriate referrals, communication errors, and inadequately prepared or informed patients. OAE can be safely used if preprocedure assessment, informed consent, information transfer,
Recommendations
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We recommend that referring providers using OAE understand the appropriate use of GI endoscopy and recognize when office consultation is necessary. ⊕○○○
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We recommend that referring providers discuss the indication for the procedure with the patient before referral for OAE. ⊕○○○
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We recommend that pertinent medical records be available to the endoscopist before the OAE procedure. ⊕○○○
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We recommend that endoscopy providers complete a preprocedure assessment of patients and obtain informed consent
Disclosure
Dr Muthusamy is a consultant for Boston Scientific and has received honoraria from Covidien GI Solutions. Dr Khashab is on the Advisory Board of, a consultant for, and has received grants from Boston Scientific; is a consultant for Olympus America; and has received grants from Cook Medical. All other authors disclosed no financial relationships relevant to this article.
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2022, Techniques and Innovations in Gastrointestinal EndoscopyCitation Excerpt :These data support that OAE can still be advantageous and safely performed, but requires careful care coordination in the days leading up to the endoscopy. Indeed, while the quality of evidence was low, the ASGE recommendations for OAE include: ensuring that referring provides understand the appropriate use of GI endoscopy (vs the need for office consultation), ensuring that referring providers discuss indication with patient prior to referral, and that pertinent medical records are available prior to the procedure.40 Recommendations also include that endoscopists complete a preprocedure assessment of patients, obtain informed consent, and communicate all results back to the patient and referring provider.
Undisclosed payments by pharmaceutical and medical device manufacturers to authors of endoscopy guidelines in the United States
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This document was developed by the ASGE Standards of Practice Committee. This document was reviewed and approved by the Governing Board of the American Society for Gastrointestinal Endoscopy.