Year 2020 / Volume 112 / Number 10
Original
Evaluation of endoscopy requests in the resumption of activity during the SARS-CoV-2 pandemic: denial of nonindicated requests and prioritization of accepted requests

748-755

DOI: 10.17235/reed.2020.7375/2020

Pilar Díez Redondo, M.ª Henar Núñez Rodríguez, Esteban Fuentes Valenzuela, Rodrigo Nájera Muñoz, Manuel Perez-Miranda,

Abstract
Introduction: the global SARS-CoV-2 pandemic forced the closure of endoscopy units. Before resuming endoscopic activity, we designed a protocol to evaluate gastroscopies and colonoscopies cancelled during the pandemic, denying inappropriate requests and prioritizing appropriate ones. Methods: two types of inappropriate request were established: a) COVID-19 context, people aged ≤ 50 years without alarm symptoms and a low probability of relevant endoscopic findings; and b) inappropriate context, requests not in line with clinical guidelines or protocols. Denials were filed in the medical record. Appropriate requests were classified into priority, conventional and follow-up. Requests denied by specialty were compared and the findings of priority requests were evaluated. Results: between March 16th and June 30th 2020, 1,658 requests (44 % gastroscopies and 56 % colonoscopies) were evaluated, of which 1,164 (70 %) were considered as appropriate (priority 8.5 %, conventional 48 %, follow-up 43 % and non-evaluable 0.5 %) and 494 (30 %) as inappropriate (20 % COVID-19 context, 80 % inappropriate context). The reasons for denial of gastroscopy were follow-up of lesions (33 %), insufficiently studied symptoms (20 %) and relapsing symptoms after a previous gastroscopy (18 %). The reasons for denial of colonoscopies were post-polypectomy surveillance (25 %), colorectal cancer after surgery (21 %) and a family history of cancer (13 %). There were significant differences in denied requests according to specialty: General Surgery (52 %), Hematology (37 %) and Primary Care (29 %); 31 % of priority cases showed relevant findings. Conclusions: according to our study, 24 % of endoscopies were discordant with scientific recommendations. Therefore, their denial and the prioritization of appropriate ones optimize the use of resources.
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References
1.- Parodi SM, Liu VX. From Containment to Mitigation of COVID-19 in the US. JAMA. 2020; 323:1441-1442.
2.- Lui RN, Wong SH, Sánchez-Luna SA et al. Overview of Guidance for Endoscopy During the Coronavirus Disease 2019 Pandemic. Gastroenterol Hepatol 2020; 35:749-759.
3.- Gralnek IM, Hassan C, Beilenhoff U et al. ESGE and ESGENA Position Statement on gastrointestinal endoscopy and the COVID-19 pandemic. Endoscopy 2020; 52:483-490
4.- Marín-Gabriel JC, Rodríguez de Santiago E. AEG-SEED Position Paper for the Resumption of Endoscopic Activity After the Peak Phase of the COVID-19 Pandemic. Gastroenterol Hepatol 2020. DOI: 10.1016/j.gastrohep.2020.05.004
5.- Crespo J, Andrade R, Alberca de Las Parras F et al. Resumption of Activity in Gastroenterology Departments. Recommendations by SEPD, AEEH, GETECCU and AEG. Rev Esp Enferm Dig 2020;112:397-411.
6.- Eskeland SL, Dalén E , Sponheim J, et al. European Panel on the Appropriateness of Gastrointestinal Endoscopy II Guidelines Help in Selecting and Prioritizing Patients Referred to Colonoscopy—A Quality Control Study. Scand J Gastroenterol 2014;49:492-500
7.- Morgan DJ, Dhruva SS, Wright SM et al. 2016 Update on Medical Overuse: A Systematic Review. JAMA Intern Med 2016;176:1687-1692.
8.- Gimeno-García AZ, Quintero E. Colonoscopy Appropriateness: Really Needed or a Waste of Time? World J Gastrointest Endosc 2015; 7:94-101.
9.- Meggio A , Mariotti G , Gentilini M et al. Priority and Appropriateness of Upper Endoscopy Out-Patient Referrals: Two-period Comparison in an Open-Access Unit. Dig Liver Dis 2019;51:1562-1566.
10.- Jong JJ , Lantinga MA, Drenth JP. Prevention of Overuse: A View on Upper Gastrointestinal Endoscopy.World J Gastroenterol 2019;25:178-189.
11.- Rubenstein JH, Pohl H, Adams MA et al. Overuse of Repeat Upper Endoscopy in the Veterans Health Administration: A Retrospective Analysis. Am J Gastroenterol 2017 ;112:1678-1685.
12.- Pohl H, Robertson D, Welch H. Repeated Upper Endoscopy in the Medicare Population: A Retrospective Analysis. Annals of Internal Medicine 2014; 160:154-160.
13.- Petruzziello L, Hassan C, Alvaro D et al. Appropriateness of the Indication for Colonoscopy: Is the Endoscopist the 'Gold Standard'? J Clin Gastroenterol 2012;46:590-594.
14.- Esteban S, Ricci R, Terrasa S, et al. Colonoscopy Overuse in Colorectal Cancer Screening and Associated Factors in Argentina: A Retrospective Cohort Study. BMC Gastroenterol 2017 ;17:162.
15.- Stock C, Hoffmeister M, Birkner B et al. Utilitation and yield of neoplasm in colonoscopies performed within 3 years after screening colonoscopy: a historical cohort study. Endoscopy 2013; 45: 537-544.
16.- Mangas Sanjuan C, Santana E, Cubiella J et al. Variation in Colonoscopy Performance Measures According to Procedure Indication. Clin Gastroenterol Hepatol 2020;18:1216-1223.
17.- Rodríguez-de-Santiago E, Frazzoni L, Fuccio L et al. Digestive findings that do not require endoscopic surveillance: Reducing the burden of care: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy 2020; 52: 491–49
18.- Schoen RE, Razzak A, Yu KJ et al. Incidence and Mortality of Colorectal Cancer in Individuals with a Family History of Colorectal Cancer. Gastroenterology 2015; 149:1438-1445.
19.- Mangas-Sanjuan C, Jover R, Cubiella J et al. Vigilancia tras resección de pólipos de colon y de cáncer colorrectal. Actualización 2018. Gastroenterol Hepatol 2019; 42: 188-201.
20.- Andújar X, Sainz E, Galí A et al. Inappropriateness Rate for Colonoscopy Indications in an Open Access Unit. Gastroenterol Hepatol 2015; 38:313-319.
21.- National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology. [Internet]2020. Consultado 23 junio 2020. Disponible en https://www.nccn.org/professionals/physician_gls/pdf/gastric.pdf
22.- Patel J, McNair A. Identification of Upper Gastrointestinal Malignancy in Patients With Uncomplicated Dyspepsia Referred Under the Two-Week-Wait Cancer Pathway: A Single-Centre, 10-year Experience. Eur J Gastroenterol Hepatol 2020; 32:22-25.
23.- Suriani R, Rizzetto M, Mazzucco D et al. Appropriateness of Colonoscopy in a Digestive Endoscopy Unit: A Prospective Study Using ASGE Guidelines. J Eval Clin Pract 2009;15:41-45.
24.- Magrath M, Yang E, Ahn Ch at al.Impact of a Clinical Decision Support System on Guideline Adherence of Surveillance Recommendations for Colonoscopy After Polypectomy. J Natl Compr Canc Netw 2018;16:1321-1328.
25.- Grassini M, Verna C, Battaglia E et al. Education Improves Colonoscopy Appropriateness. Gastrointest Endosc 2008;67:88-93.
26.- Elwin G, Owen D, Roberts L et al. Influencing referral practice using feedback of adherence to NICE guidelines: a quality improvement report for dyspepsia. Qual Saf Health Care 2007; 16:67-70
27.- Chivers K, Basnyat P, Taffinder N. The Impact of National Guidelines on the Waiting List for Colonoscopy: A Quantitative Clinical Audit.Colorectal Dis 2010;12:632-639.
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Díez Redondo P, Núñez Rodríguez M, Fuentes Valenzuela E, Nájera Muñoz R, Perez-Miranda M. Evaluation of endoscopy requests in the resumption of activity during the SARS-CoV-2 pandemic: denial of nonindicated requests and prioritization of accepted requests. 7375/2020


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Publication history

Received: 26/06/2020

Accepted: 18/07/2020

Online First: 21/09/2020

Published: 07/10/2020

Article revision time: 12 days

Article Online First time: 87 days

Article editing time: 103 days


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