ASGE Guidelines: A Study of Appropriateness and Usefulness Comparing a Gastroenterology Training Program, a General Surgery Residency Program, and a Gastroenterology Private Practice

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Wide availability of excellent instrumentation has made it possible for large numbers of differently trained physicians to perform endoscopic procedures, including Gastroenterologists, Surgeons and Family Practitioners. However, changing trends in medicine to more cost effective practice have made it important to place greater emphasis on appropriateness and usefulness. The ASGE has published guidelines for appropriate use of endoscopy. Aim: To compare a Gastroenterology Fellowship Program (GFP), a Surgery Residency (GSR), and a Private Gastroenterology Practice (PGP) with regards to adherence to ASGE guidelines and relevance. Methods: Three-hundred records of patients who underwent Esophagogastroduodenoscopy (EGD) were evaluated retrospectively. The indication for endoscopy was classified as indicated or not indicated according to the ASGE guidelines. EGDs not indicated were further classified as relevant, if a change in management was probable based on findings, or not relevant, if no change in management was probable. Results: Group N Indicated Not Ind. Relevant Not Relevant GFP 100 91 9*8/9 (89%) # 1/9 (11%) GSR 100 47 53**11/53 (21%) ## 42/53 (79%) PGP 100 80 20***13/20 (65%) ### 7/20 (35%) Total 300 215 (72%) 82 (28%) 32/82 (39%) 50/82 (61%)*p < .001 vs all other ;**p < .001 vs all other:***p < .001 vs GSR, p = .023 vs GFP; # p< .001 vs GSR, not significant vs PGP; ## p < .001 vs all other; ### p < .001 vs GSR, not significant ys GFP. Conclusions: The rate of inappropriate use of EGD was highest in the Surgery Residency group along with the lowest rate of relevant findings. Private Gastroenterology Practice also had a high rate of inappropriate usage, but relevant findings were not significantly different from Gastroenterology Fellowship. Appropriate use of EGD could be improved in all study groups. The ASGE guidelines could be more strictly applied.