Appropriateness guidelines and predictive rules to select patients for upper endoscopy

A nationwide multicenter study

Luigi Buri, Cesare Hassan, Gianluca Bersani, Marcello Anti, Maria Antonietta Bianco, Livio Cipolletta, Emilio Di Giulio, Giovanni Di Matteo, Luigi Familiari, Leonardo Ficano, Pietro Loriga, Sergio Morini, Vincenzo Pietropaolo, Alessandro Zambelli, Enzo Grossi, Marco Intraligi, Massimo Buscema

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Objectives: Selecting patients appropriately for upper endoscopy (EGD) is crucial for efficient use of endoscopy. The objective of this study was to compare different clinical strategies and statistical methods to select patients for EGD, namely appropriateness guidelines, age and/or alarm features, and multivariate and artificial neural network (ANN) models.Methods: A nationwide, multicenter, prospective study was undertaken in which consecutive patients referred for EGD during a 1-month period were enrolled. Before EGD, the endoscopist assessed referral appropriateness according to the American Society for Gastrointestinal Endoscopy (ASGE) guidelines, also collecting clinical and demographic variables. Outcomes of the study were detection of relevant findings and new diagnosis of malignancy at EGD. The accuracy of the following clinical strategies and predictive rules was compared: (i) ASGE appropriateness guidelines (indicated vs. not indicated), (ii) simplified rule (≤45 years or alarm features vs. >45 years without alarm features), (iii) logistic regression model, and (iv) ANN models.Results: A total of 8,252 patients were enrolled in 57 centers. Overall, 3,803 (46%) relevant findings and 132 (1.6%) new malignancies were detected. Sensitivity, specificity, and area under the receiver-operating characteristic curve (AUC) of the simplified rule were similar to that of the ASGE guidelines for both relevant findings (82%/26%/0.55 vs. 88%/27%/0.52) and cancer (97%/22%/0.58 vs. 98%/20%/0.58). Both logistic regression and ANN models seemed to be substantially more accurate in predicting new cases of malignancy, with an AUC of 0.82 and 0.87, respectively. Conclusions: A simple predictive rule based on age and alarm features is similarly effective to the more complex ASGE guidelines in selecting patients for EGD. Regression and ANN models may be useful in identifying a relatively small subgroup of patients at higher risk of cancer.

Original languageEnglish
Pages (from-to)1327-1337
Number of pages11
JournalAmerican Journal of Gastroenterology
Volume105
Issue number6
DOIs
Publication statusPublished - Jun 2010

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Endoscopy
Multicenter Studies
Gastrointestinal Endoscopy
Neural Networks (Computer)
Guidelines
Logistic Models
Neoplasms
Area Under Curve
ROC Curve
Referral and Consultation
Demography
Outcome Assessment (Health Care)
Prospective Studies
Sensitivity and Specificity

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Appropriateness guidelines and predictive rules to select patients for upper endoscopy : A nationwide multicenter study. / Buri, Luigi; Hassan, Cesare; Bersani, Gianluca; Anti, Marcello; Bianco, Maria Antonietta; Cipolletta, Livio; Di Giulio, Emilio; Di Matteo, Giovanni; Familiari, Luigi; Ficano, Leonardo; Loriga, Pietro; Morini, Sergio; Pietropaolo, Vincenzo; Zambelli, Alessandro; Grossi, Enzo; Intraligi, Marco; Buscema, Massimo.

In: American Journal of Gastroenterology, Vol. 105, No. 6, 06.2010, p. 1327-1337.

Research output: Contribution to journalArticle

Buri, L, Hassan, C, Bersani, G, Anti, M, Bianco, MA, Cipolletta, L, Di Giulio, E, Di Matteo, G, Familiari, L, Ficano, L, Loriga, P, Morini, S, Pietropaolo, V, Zambelli, A, Grossi, E, Intraligi, M & Buscema, M 2010, 'Appropriateness guidelines and predictive rules to select patients for upper endoscopy: A nationwide multicenter study', American Journal of Gastroenterology, vol. 105, no. 6, pp. 1327-1337. https://doi.org/10.1038/ajg.2009.675
Buri, Luigi ; Hassan, Cesare ; Bersani, Gianluca ; Anti, Marcello ; Bianco, Maria Antonietta ; Cipolletta, Livio ; Di Giulio, Emilio ; Di Matteo, Giovanni ; Familiari, Luigi ; Ficano, Leonardo ; Loriga, Pietro ; Morini, Sergio ; Pietropaolo, Vincenzo ; Zambelli, Alessandro ; Grossi, Enzo ; Intraligi, Marco ; Buscema, Massimo. / Appropriateness guidelines and predictive rules to select patients for upper endoscopy : A nationwide multicenter study. In: American Journal of Gastroenterology. 2010 ; Vol. 105, No. 6. pp. 1327-1337.
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AU - Buri, Luigi

AU - Hassan, Cesare

AU - Bersani, Gianluca

AU - Anti, Marcello

AU - Bianco, Maria Antonietta

AU - Cipolletta, Livio

AU - Di Giulio, Emilio

AU - Di Matteo, Giovanni

AU - Familiari, Luigi

AU - Ficano, Leonardo

AU - Loriga, Pietro

AU - Morini, Sergio

AU - Pietropaolo, Vincenzo

AU - Zambelli, Alessandro

AU - Grossi, Enzo

AU - Intraligi, Marco

AU - Buscema, Massimo

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