Appropriatezza e utilità diagnostica dell'endoscopia del tratto gastroenterico superiore nel sistema open access endoscopy

The discovery of H. pylori has dramatically changed the management of acid related diseases. The present study tests the appropriateness of referrals for upper gastrointestinal endoscopy in Campania, using the criteria of the Maastricht consensus. Patients undergoing endoscopy during a one-week period in 21 Endoscopy Services of Campania were prospectively considered. The reasons for endoscopy were dyspectic symptoms, history of peptic ulcer, and riced of control after treatment. The following data were recorded: age, sex, symptoms, history of peptic ulcer with regards to previous endoscopic or radiographic examinations, and treatment endoscopic diagnosis, and H. pylori status. Indication for endoscopy was evaluated according to Maastricht guidelines. Among the 706 patient considered, 316 showed reflux symptoms, 330 dyspeptic symptoms of different rypes, 38 alarm symptoms, and 22 atypical symptoms. Endoscopy was normal in 346 patients (49%); duodenal ulcer was found in 219, gastric ulcer in 39, esophagitis in 82 and gastric cancer in 6. All patients with cancer were older than 45 and 4 of them presented with alarm symptoms. In 398 cases (56.4%) endoscopy was considered not indicated when performed in 250 patients with a previous endoscopic or radiologic diagnosis of ulcer without changing of symptoms, in 38 patients in order to confirm eradication, and in 110 patients younger than 45 with dyspepsia without alarm symptoms. The appropriate endoscopies did not yield more relevant lesions than did those judged to be inappropriate. A large number of endoscopic examinations are not indicated and could be avoided following the guidelines of Maastricht. In order to reduce the endoscopic workload and optimize the treatment of Hp infection, strategics for educating physician should be pursued.