Overuse of Upper Gastrointestinal Endoscopy in a Country with Open-Access Endoscopy

Reports the results of a prospective observational study aimed at evaluating the appropriateness of use of upper gastrointestinal endoscopy (UGE) in primary care in a country with open access to, and high availability of, the procedure. Outpatients were consecutively included in two clinical settings, both in Switzerland, which consisted of either a university-based outpatient clinic or primary care physicians' offices. Appropriateness was judged by explicit Swiss criteria developed by the RAND/UCLA panel method. Of over 8,000 patients who presented to these offices, about 600 had upper GI symptoms. Physicians decided to perform upper GI endoscopy in 63 of these patients. Of these 63 procedures, 40% were rated appropriate, 11% equivocal, and 49% inappropriate. The decision to perform UGE in previously untreated dyspeptic patients was the most common clinical situation resulting in overuse. This article concluded that overuse of UGE is high in Switzerland and needs to be reduced.