A closer look at same-day bidirectional endoscopy - 23/08/11
Reprint requests: Jennifer Urquhart, MD, Department of Gastroenterology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Mailcode L-461, Portland, OR 97239.Portland, Oregon, USA
Abstract |
Background |
Same-day bidirectional endoscopy (BDE) is commonly used in clinical practice.
Objective |
Our purpose was to determine the frequency, patient demographics, indications, and significant endoscopic findings for patients undergoing BDE.
Design |
Retrospective study with a national endoscopic database.
Setting |
Diverse clinical practice settings in the United States, including 75% from private practice.
Patients |
A total of 591,074 adult patients had upper or lower endoscopy; 66,265 patients (11.2%) with same-day BDE and a subgroup (n = 9067) with a common indication for both upper and lower examinations are the subjects of this analysis.
Main Outcome Measurements |
Age, sex, and procedure indication were analyzed in all subjects. Significant endoscopic findings were measured in patients with a single indication of anemia, a positive fecal occult blood test (FOBT), or abdominal pain/dyspepsia (pain) for both upper and lower endoscopy.
Methods |
The Clinical Outcomes Research Initiative (CORI) national endoscopic database was analyzed to determine the number of patients who underwent same-day BDE between 2000 and 2004. Patients with a single indication of anemia, positive fecal occult blood test (FOBT), or abdominal pain/dyspepsia (pain) on both EGD and colonoscopy were included for the analysis of endoscopic findings. Significant upper GI findings were defined as suspected malignancy, arteriovenous malformation (AVM), ulcer, Barrett’s esophagus, and stricture. Significant lower GI findings included suspected malignancy, polyp >9 mm, and AVM.
Results |
A total of 591,074 patients had upper and/or lower endoscopy; 66,265 patients (11.2%) had same-day BDE. The majority of patients were female (52.1%), and the mean age of patients with BDE was 60.8 years. A total of 6538 patients (9.9%) had anemia, 1169 (1.8%) had a positive FOBT, and 1360 (2.1%) had pain as the sole indication for both examinations. After adjustment for age and sex, significant findings were higher in patients with anemia than in those with pain (odds ratio 1.89; 95% CI, 1.59-2.26) and for patients with positive FOBT versus pain (odds ratio 1.83; 95% CI, 1.48-2.26).
Limitations |
Retrospective analysis with possible bias. Fewer patients with pain had significant findings compared to the other two groups (P value <.0001).
Conclusions |
More than 10% of patients undergoing upper or lower endoscopy receive same-day BDE. BDE commonly revealed important conditions in patients with anemia or positive FOBT. Bidirectional endoscopy commonly revealed important pathology in patients with anemia or positive FOBT. Patients with pain had a lower prevalence of serious findings compared to the other groups studied. The benefits of BDE in patients with pain are uncertain and require additional investigation.
Il testo completo di questo articolo è disponibile in PDF.Abbreviations : AVM, BDE, CORI, FOBT, OR
Mappa
| DISCLOSURE: All authors disclosed no financial relationships relevant to this publication. D. A. Lieberman is the executive director of CORI, a nonprofit organization that receives funding from federal and industry sources. The CORI database was used in this study. This potential conflict of interest has been reviewed and managed by the OHSU Conflict of Interest in Research Committee. |
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| Grant Support: This project was supported with funding from NIDDK UO1 CA 89389-01 and the American Cancer Society. In addition, the practice network (Clinical Outcomes Research Initiative) has received support from the following entities to support the infrastructure of the practice-based network: AstraZeneca, Bard International, Pentax USA, ProVation, Endosoft, GIVEN Imaging, and Ethicon. The commercial entities had no involvement in this research. Dr. Lieberman is the executive director of the Clinical Outcomes Research Initiative (CORI), a non-profit organization that receives funding from federal and industry sources. The CORI database is used in this study. This potential conflict of interest has been reviewed and managed by the OHSU Conflict of Interest in Research Committee. This project was supported with funding from NIDDK UO1 CA 89389-01 and the American Cancer Society. In addition, the practice network (CORI) has received support from the following entities to support the infrastructure of the practice-based network: AstraZeneca, Bard International, Pentax USA, ProVation, Endosoft, GIVEN Imaging, and Ethicon. The commercial entities had no involvement in this research. |
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| If you want to chat with an author of this article, you may contact him at urquhart@ohsu.edu. |
Vol 69 - N° 2
P. 271-277 - febbraio 2009 Ritorno al numero
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