Saudi Journal of Gastroenterology
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Year : 1997  |  Volume : 3  |  Issue : 3  |  Page : 130-132
Impact of open access endoscopy on early diagnosis, treatment and gastrointestinal radiology service


Department of Internal Medicine, Armed Forces Hospital, P.O. Box 101, Khamis Mushayt, Saudi Arabia

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Date of Submission01-Jan-1996
Date of Acceptance05-Aug-1997
 

   Abstract 

The objective is to compare the endoscopic findings before and after initiation of open access and its effect on gastrointestinal radiology services. The data of endoscopic findings before open access endoscopy (July, 1989-June, 1992) and after open access endoscopy (July, 1992-June, 1995) was collected from the records of the endoscopy unit. Similarly, data of barium meals for the same periods was collected from the radiology department. An X 2 test was used to compare the endoscopic findings before and after open access policy. It is found that open access endoscopy increased the workload in the endoscopy unit but at the same time reduced the number of gastrointestinal radiological procedures. It reduced the waiting period for endoscopy and this helped in making early diagnosis and initiation of appropriate treatment.

How to cite this article:
Tiwari I, Uddin W, Mazhar Z. Impact of open access endoscopy on early diagnosis, treatment and gastrointestinal radiology service. Saudi J Gastroenterol 1997;3:130-2

How to cite this URL:
Tiwari I, Uddin W, Mazhar Z. Impact of open access endoscopy on early diagnosis, treatment and gastrointestinal radiology service. Saudi J Gastroenterol [serial online] 1997 [cited 2019 May 25];3:130-2. Available from: http://www.saudijgastro.com/text.asp?1997/3/3/130/33921


Providing open access gastroscopy for general practitioners helps to achieve more rapid diagnosis and treatment to patients with symptoms of dyspepsia [1] . It also reduces the burden on hospital Outpatients depathuents [2] . Although it is becoming more widely available in the hospitals in the United Kingdon, many endoscopists are still reluctant to offer the service due to fear of inability to cope with the numbers [3] . Some earlier studies reported that this service had no effect on referral for barium meal examinations [4] but Gear and Wilkinson found 50% reduction in Barium Meal requests after provision of open access endoscopies [5] . The aim of our study was to compare endoscopic findings before and after availability of open access endoscopy and its effect on early diagnosis which will help initiate early treatment. We also tried to find the effect of open access endoscopy on the waiting list for endoscopy, workload on endoscopy unit and on the requests for barium meal examinations.


   Patients and methods Top


This study was conducted at the Armed Forces Hospital in the southern region of Saudi Arabia. This is a retrospective study. The hospital provides service to military personnel and their dependents. Primary care service is provided by the general practitioners who conduct their clinics at various primary care centers managed by the same hospital. They have access to all investigations in the hospital.

An open access upper gastrointestinal endoscopy service for general practitioners was started in July, 1992. Before this, patients requiring endoscopy were referred initially to gastroenterology clinics and arrangements for endoscopy were made after seeing the patient in gastroenterology clinic. The general practitioners had direct access for barium meal examinations both before and after availability of open access endoscopy.

In this study we have compared the endoscopic findings in 787 patients before open access endoscopy (July, 1989 to June, 1992) and 1873 patients after open access (July, 1992 to June 1995) to find out its effect on the number of barium meal examinations.

The general practitioners were informed about the availability of open access endoscopy and also advised that gastroscopy should be preferrable to barium meal examination for a patient who needs investigation for dyspepsia.

The data was collected from the records of endoscopy unit and the radiology department. The age and sex distribution was similar in both groups. An X 2 test was used to compare the endoscopic findings before and aftert endoscopy and a probability level of 0.05 was regarded as significant.


   Results Top


A total of 787 subjects had upper GI endoscopy performed in three years before and 1873 in three years after availability of open access endoscopy. The total number of endoscopies performed yearly is shown in [Figure - 1]. There had been an increase of more than two-fold from an average 262 to 624 per year after the availability of open access.

Endoscopic findings in both groups are summarized in [Table - 1]. There has been an increase of eight percent in proportion of normal examinations which is significant (P<0.001). The proportion of most of the other diagnosis has remained similar and statistically no significant difference has been noted.

Open access endoscopy has reduced the time interval, from first attendance at a general practitioner clinic to endoscopy. The waiting period for a new referral to gastrointestinal clinic is about four weeks and it takes another four weeks for endoscopy appointment. With availability of open access endoscopy the time interval from first visit to the general practitioner clinic to endoscopy was reduced to four weeks and this helped in making early diagnosis and initiating treatment earlier.

As the number of referrals to endoscopy had increased from an average of 262 per year to 624 per year, we had to increase the number of endoscopy sessions to cope with the increased workload.


   Discussion Top


Endoscopy is more accurate than barium meal examination for diagnosing lesions in the upper gastrointestinal tract [6] but many endoscopy units are reluctant to provide open access endoscopy due to fear of massive increase in the workload and an unacceptable increase in the number of unnecessary examinations [1] . Other studies show that open access endoscopy does not cause an increase in the number of normal examinations. Although in our study the number of normal examinations increased from 36.1 to 44.1% (P=0.00013 5 S), this is still within the range of normal examinations of 40%­50% reported from other endoscopy units [1],[5] . The normal endoscopy provides strong reassurance for doctors and patients and leads to less empirical treatment, thus reducing prescribing costs; negative endoscopic findings thus have a positive outcome [7] .

Open access endoscopy also permits more rapid diagnosis as one unnecessary attendance to the speciality clinic is avoided and appropriate treatment can be started earlier. As most of the abnormalities detected at endoscopy can be treated by general practitioners, needless referrals of large numbers of patients with dyspepsia to speciality clinic can be avoided. Conditions for which specialist hospital treatment is required are immediately referred to appropriate consultant from endoscopy unit [5] . Prompt endoscopy is also more cost effective in comparision to empirical H2 blocker treatment in the management of patients with dyspepsia [8] .

Other beneficial effect of open access endoscopy seems to be on the workload of radiology department. Endoscopy is superior to radiology and gives additional advantage of obtaining biopsy of gastric mucosa to diagnose H pylori, which is responsible for 95% of duodenal ulcers and its eradication leads to longterm cure [6],[9] . Non­invasive serological tests can detect H pylori, but endoscopy is indicated in those patients to diagnose gastro-duodenal ulcers [10] . Endoscopy is also essential to get the specimen for histological examination for malignant disease.

Holdstock et al reported that open access endoscopy had little or no effect on referrals for barium meal examination while Gear and Wilkinson showed 50% reduction in barium meal requests [4],[5] . Our study supports their observation with almost 58% reduction in the request for barium meal examination after availability of open access endoscopy to general practitioners. This reduces the burden on radiology staff, who can utilize this time for other essential investigations. We recommend that open access endoscopy helps in early diagnosis and treatment and reduces the workload of radiology department and thus it should be available to general practitioners.

 
   References Top

1.Kerrigan BD, Brown SR, Hutchinson GH, Open access gastroscopy; Too much to swallow ? BMJ 1990;300:374-6.  Back to cited text no. 1    
2.Fisher JA, Surridge JG, Vartan CP, Lochry CA. Upper gastrointestinal endoscopy - A G.P. Service. BMJ 1979;11:1199-201.  Back to cited text no. 2    
3.Bramble MG. Open access endoscopy - A nationwide survey of current practice. Gut 1992;33:282-5.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.Hodlstock G, Wiseman M, Lochry CA. Open access endoscopy service for General Practitioners. BMJ 1979;1:457-9.  Back to cited text no. 4    
5.Gear MWL, Wilkinson SP. Open access upper alimentary endoscopy. Br J Hosp Med 1979;41:438-44.  Back to cited text no. 5    
6.Colin-Jones DG. Endoscopy or radiology for upper gastrointestinal symptoms ? Lancet 1986;I:1022-3.  Back to cited text no. 6    
7.Jones R. What happens to patients with non-ulcer dyspepsia after endoscopy ? Practitioner 1988;232:75-8.  Back to cited text no. 7  [PUBMED]  
8.Bytzer P, Moller-Hansen J, Schaffalitzky de Muchadell OB. Empirical H2 - blockers therapy or prompt endoscopy in Management of Dyspepsia. Lancet 1994;343:811-6.  Back to cited text no. 8    
9.Helicobacter pylori: casual agent in peptic ulcer disease Working party report to the World Congress of Gastroenterology, Sydney, 1990. J Gastroenterol Hepatol. 1991;6:103-40.  Back to cited text no. 9    
10.Axon ATR, Bell GD, Jones RH, Quine MA, McCloy RF. Guidelines as appropriate indication for upper gastrointestinal endoscopy. BMJ 1995;310:853-6.  Back to cited text no. 10    

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Correspondence Address:
Wasim Uddin
Gastroenterologist/Hepatologist, Armed Forces Hospital, P.O. Box 101, Khamis Mushayt
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


PMID: 19864790

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