Effective coordination between Primary Care (PC) and hospital-based endoscopy units plays a crucial role in improving early diagnosis and timely detection of relevant gastrointestinal pathology. The increasing demand for endoscopic procedures requires the implementation of standardized referral pathways to ensure adequate patient selection, avoid inappropriate indications, and prioritize individuals at higher risk. Structured collaboration, supported by evidence-based protocols and continuous feedback to referring clinicians, can improve efficiency, reduce unnecessary procedures, and enhance diagnostic performance across the healthcare system.

To evaluate the indications, appropriateness, acceptance, and reasons for rejection of endoscopies requested from PC during 2024, while assessing the influence of clinical referral protocols and the colorectal cancer (CRC) screening program on decision-making and final scheduling outcome

A retrospective descriptive analysis was performed of all digestive endoscopy requests submitted from PC throughout 2024. Data collected included reason for referral, compliance with predefined clinical criteria and CRC Screening Program requirements, type of endoscopy requested, and whether the procedure was accepted, temporarily deferred, or definitively rejected. Reasons for non-acceptance were categorized according to predefined clinical and organizational criteria.

A total of 3,281 endoscopy requests from PC were evaluated: 1,289 gastroscopies (95.3% accepted), 1,830 colonoscopies (86% accepted), and 162 combined procedures (95% accepted). The overall rejection rate was 9%. For gastroscopies, the leading causes of rejection were uncomplicated dyspepsia without alarm features and without prior Helicobacter pylori testing (37.7%), followed by inadequate or prematurely requested surveillance of previously detected lesions (34.4%). For colonoscopies, the most frequent reasons for rejection were post-polypectomy surveillance intervals not aligned with clinical guideline recommendations (39%) and inappropriate requests related to family-history–based CRC screening (32%). Among colonoscopies requested within the CRC Screening Program (n = 1,124), 16% were rejected for failing to meet program criteria. The most common causes were a previous colonoscopy performed within the last 10 years (50.55%) and the presence of gastrointestinal symptoms (17.58%); most symptomatic patients were subsequently reassigned as diagnostic colonoscopies. A comparative evaluation with previous years showed a progressive reduction in inappropriate referrals (Table)

The structured implementation of shared referral protocols between PC and the Endoscopy Unit, together with systematic assessment of indication appropriateness, has led to a measurable improvement in the quality of endoscopy requests. This has contributed to reducing

unnecessary procedures, optimizing resource allocation, and enhancing diagnostic yield. Sustained communication with PC, ongoing updates on referral criteria, and feedback on screening indications remain essential to consolidate and further strengthen this positive trend.