Usefulness of a fast track list for anxious patients in a upper GI endoscopy

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Abstract

Background

To determine whether patients with no alarm signs who ask the endoscopist to shorten their waiting time due to test result anxiety, represent a risk category for a major organic pathology.

Methods

At our open-access endoscopy service, we set up an expedite list for six months for outpatients who complained that the waiting time for gastroscopy was too long. Over this period we studied 373 gastroscopy patients. In addition to personal details, we collected information on the presence of Hp infection and compliance with dyspepsia guideline indications for gastroscopy.

Results

Average waiting time was 38.2 days (SD 12.7). The 66 patients who considered the waiting time too long underwent gastroscopy within 15 days. We made 5 diagnoses of esophageal and gastric tumour and gastric ulcer (7.6%) among the expedite list patients and 14 (4.6%) among those on the normal list (p=0.31). On including duodenal peptic disease in the analysis, the total prevalence rate rose to 19.7% in the short-wait group and to 10.4% (p=0.036) in the longer-wait group.

Discussion and conclusions

Our data suggests that asking to be fast-tracked does not have prognostic impact on the diagnosis of a major (gastric ulcer and cancer) pathology.

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Most cited references 25

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Limited value of alarm features in the diagnosis of upper gastrointestinal malignancy: systematic review and meta-analysis.

M. Fennerty, Nicholas J. Talley, Paul Moayyedi … (2006)

Alarm features such as dysphagia, weight loss, or anemia raise concern of an upper gastrointestinal malignancy in patients with dyspepsia. The aim of this study was to determine the diagnostic accuracy of alarm features in predicting malignancy by performing a metaanalysis based on the published literature. English-language studies were identified by searching MEDLINE, EMBASE, Cochrane Controlled Trials Register, and CINAHL. Cohort studies that measured alarm features and compared them with the endoscopic findings were included. Studies were screened for inclusion by 2 authors who independently extracted the data. Sensitivity, specificity, and likelihood ratios were calculated by comparing the alarm feature with the endoscopic diagnosis. The summary receiver operating characteristic curve method was used to summarize test characteristics across studies. Individual alarm features were also assessed when the study report permitted. Eighty-three of 2600 studies met the initial screening criteria; 15 met inclusion criteria after detailed review. These 15 studies evaluated a total of 57,363 patients, of whom 458 (.8%) had cancer. The sensitivity of alarm symptoms varied from 0% to 83% with considerable heterogeneity between studies. The specificity also varied significantly from 40% to 98%. A clinical diagnosis made by a physician was very specific (range, 97%-98%) but not very sensitive (range, 11%-53%). Alarm features have limited predictive value for an underlying malignancy. Their use in dyspepsia management strategies needs further refinement and study.

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Predictive value of alarm features in a rapid access upper gastrointestinal cancer service.

N Kapoor, A. Bassi, R Sturgess … (2005)

(i) To determine the value of individual alarm features for predicting cancer in subjects referred to a rapid access upper gastrointestinal cancer service; and (ii) to develop a clinical prediction model for cancer and to prospectively validate this model in a further patient cohort. Patient demographics, referral indications, and subsequent diagnosis were recorded prospectively. Logistic regression analyses were employed to determine the predictive value of individual alarm features in an evaluation cohort of 1852 consecutive cases. The potential impact of applying a modified set of referral criteria was then examined in a validation cohort of 1785 patients. Evaluation cohort: mean age was 59 years; cancer prevalence 3.8%; and serious benign pathology 12.8%. Dysphagia (odds ratio (OR) 3.1), weight loss (OR 2.6), and age >55 years (OR 9.5) were found to be significant predictive factors for cancer but the value of other accepted alarm features was more limited. In particular, uncomplicated dyspepsia in those over 55 years was a negative predictive factor for cancer within this high risk cohort (OR 0.1). Validation cohort: the clinical prediction model would have selected 92% of cancer patients for fast track investigation while reducing the "two week rule" workload by 572 cases (31%). Fast track endoscopy in subjects fulfilling current criteria for suspected upper gastrointestinal malignancy results in a significant yield of cancer ( approximately 4%) and serious benign diseases such as peptic ulceration, strictures, and severe oesophagitis (13%). However, the predictive value of individual features for cancer varies widely. Uncomplicated dyspepsia in older subjects was a poor predictor of cancer. Application of narrower referral criteria for accessing fast track services may reduce pressures while retaining high sensitivity for cancer.

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Nonattendance at outpatient endoscopy.

I W G Forbes, Amy J Pawlik, Jennifer Adams (2004)

Nonattendance at outpatient endoscopy leads to inefficiency and delay in diagnosis. We aimed to identify factors associated with failure to attend outpatient gastroscopy and colonoscopy. We carried out a retrospective audit of nonattendance at outpatient endoscopy over a 12-month period at our tertiary hospital endoscopy unit. Attending patients on the same endoscopy list were used as controls. Patient charts and referral letters were reviewed. The information collected included referral source, time between referral and procedure, indication and type of procedure, reason for nonattendance and history of previous endoscopy. Following the audit a trial of telephone reminders was implemented over a 3-month period. From 2157 outpatient procedures that were scheduled, 263 nonattendees (12.2 %) were identified with 261 controls. Of the nonattendees, 109 (41 %) did not attend for colonoscopy, 121 (46 %) did not attend for gastroscopy and 33 (13 %) failed to turn up for combined procedures. Monday was the most common day of the week for nonattendance (40 % of nonattenders). Nonattendees were younger (46 +/- 14 vs. 55 +/- 16, P < 0.001), less likely to be referred from a gastroenterologist ( P < 0.001) or private practice ( P = 0.02) and more likely to be referred from the emergency department ( P = 0.007). Subsequent to this, a 3-month period of telephone reminder reduced nonattendance rates from 12.2 % to 9 % ( P = 0.03). Younger patients scheduled for outpatient endoscopy on Mondays who are not referred by a gastroenterologist or private physician are more likely not to attend. These patients should be targeted for interventions designed to increase attendance. Telephone reminders have a modest effect on reducing nonattendance rates.

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Author and article information

Conference

Journal ID (nlm-ta): BMC Surg

Journal ID (iso-abbrev): BMC Surg

Title: BMC Surgery

Publisher: BioMed Central

ISSN (Electronic): 1471-2482

Publication date Collection: 2012

Publication date (Electronic): 15 November 2012

Volume: 12

Issue: Suppl 1

Page: S11

Affiliations

[1 ]Department of Surgical and Gastroenterological Sciences, University of Padua, Italy

[2 ]Explora snc di Vittadello Fabio & C. - Ricerca & Analisi statistica Padova, Italy

[3 ]Istituto Oncologico Veneto, IRCCS, Padova, Italy

[4 ]Department of Molecular Medicine, University of Padua, Italy

[5 ]University of Naples Federico II - Department of General Surgery, Italy

Article

Publisher ID: 1471-2482-12-S1-S11

DOI: 10.1186/1471-2482-12-S1-S11

PMC ID: 3499366

PubMed ID: 23173721

SO-VID: bba3afa8-83c4-4d51-84ee-c986e5958c08

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Conference name: XXV National Congress of the Italian Society of Geriatric Surgery

Usefulness of a fast track list for anxious patients in a upper GI endoscopy

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Abstract

Background

Methods

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Discussion and conclusions

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Karger: Dermatology

Most cited references 25

Limited value of alarm features in the diagnosis of upper gastrointestinal malignancy: systematic review and meta-analysis.

Predictive value of alarm features in a rapid access upper gastrointestinal cancer service.

Nonattendance at outpatient endoscopy.

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