Aims
Proper prioritization is essential for optimizing waiting lists and ensuring that endoscopic procedures provide meaningful diagnostic value. This study aimed to evaluate whether a gastroenterologist’s review of General Pratictioners (GP)-issued referrals could improve appropriateness and enhance the detection of clinically significant findings.
Methods
A single-center retrospective observational study was conducted, including all patients who underwent upper or lower gastrointestinal endoscopy between January 2022 and December 2024. All referrals were issued by GP with a 60 day-priority. Patients were divided into two cohorts: the “GP” group, in which booking occurred directly through the regional scheduling system without specialist input, and the “Specialist” group, in which a gastroenterologist reviewed and, if necessary, modified the assigned priority before scheduling. Appropriateness was assessed using italian (Raggruppamenti di Attesa Omogenea, RAO)1 and American Society for Gastrointestinal Endoscopy (ASGE)2 criteria, and endoscopic outcomes were evaluated for significant organic pathology.
Results
A total of 602 patients (302 in the “Specialist” group and 300 in the “GP” group) were included in the study. The “Specialist” cohort demonstrated markedly improved appropriateness of referrals according to RAO (77.5% vs 59.0%, p<0.001) and ASGE (94.0% vs 83.0%, p<0.001) criteria and increased rates of significant organic pathology (23.2% vs. 15.0%, p=0.014), both neoplastic (2.6% vs 2%) and non-neoplastic (20.5% vs 13%), compared with CUP. Across both cohorts, appropriate referrals were associated with a higher diagnostic yield and no neoplastic lesions were found in examinations classified as inappropriate.
The general features of the two cohorts and the more significant results are summarized in Table 1.
Table 1
|
Specialist (n=302) |
GP (n=300) |
p-value |
|
|
Female sex |
145 (48,0%) |
176 (58,7%) |
|
|
Age (yrs; mean, SD) |
63,71 (15,36) |
62,81 (14,34) |
|
|
Esophagogastroduodenoscopy |
191 (63,2%) |
132 (44,0%) |
|
|
Colonoscopy |
111 (36,8%) |
168 (56,0%) |
|
|
RAO criteria |
234 (77,5%) |
177 (59,0%) |
<0,001 |
|
ASGE criteria |
284 (94%) |
249 (83%) |
<0,001 |
|
Significant pathology* |
70 (23,2%) |
45 (15,0%) |
0,014 |
|
Neoplastic disease (GC/CRC) |
8 (2,6%) |
6 (2,0%) |
0,078 |
|
Non-neoplastic disease |
62 (20,5%) |
39 (13,0%) |
0,016 |
*Esophageal varices, Barrett’s esophagus, erosive esophagitis grade C/D, eosinophilic/infectious esophagitis, gastric cancer (GC), gastric/duodenal ulcers, gastric antral vascular ectasia, gastric varices, endoscopic findings suspicious for coeliac disease, colorectal cancer (CRC), active inflammatory bowel disease, acute diverticulitis,recurrence of previously endoscopically resected lesion, high-risk colorectal polyp, anastomotic stenosis, rectal fistula, radiation proctitis
Conclusions
Specialist review enhances prioritization accuracy and overall diagnostic yield, suggesting that implementing specialist triage may help manage the increasing demand for endoscopic procedures.