An audit of open access upper gastrointestinal endoscopy by physicians in a rural hospital in Kerala, India

Shuba Srinivasan, Jyothi Lingegowda, Sneha Thomas, Ramkumar Kurpad R, Prakash Muddegowda


Access to endoscopy in India, particularly in a rural setup, is limited by the cost, trained personnel and limited resources. Literature suggests inappropriate referrals to be high, thereby over stretching this limited procedure, resulting in over-servicing. The present study was carried out to evaluate adherence of primary care physicians to ASGE guidelines when referring patients for upper GI endoscopy in rural Indian population. An observational cross-sectional study on consecutive patients referred to Department of Medicine for upper GI endoscopy. Patients above the age of 40 years were included in the study. All dyspeptic patients above the age of 50 years or patients with alarm findings were considered as appropriate referrals. Descriptive statistics was done.315 patients were included in the study. Appropriate referrals were 57.14%. Majority of the referrals were for dyspepsia and pain abdomen. Among all patients, H pylori infection was positive by rapid urease test in 55.23% indicating inadequate eradication therapy. Important endoscopic findings among the patients were carcinoma stomach, gastric/ duodenal ulcer, varices and gastritis. Among patients with dyspepsia, malignancies were noted in 1.96% of patients. Even though appropriate indications were high, the percentage of positive findings among dyspeptic patients was very low. Adequate eradication therapy for H pylori and empirical acid suppression therapy to reduce symptoms of dyspepsia as well as following strict guidelines for appropriate referrals will improve patient selection for upper GI endoscopy. This can improve efforts aimed at enhancing positive pathology identification, improved quality and efficiency of care.

Keywords: Upper gastrointestinal, Endoscopy, Audit, Appropriate, Referrals

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