CAN ENDOSCOPISTS PREDICT LESIONS AT UPPER GI ENDOSCOPY (EGD)? AN EVALUATION OF THE 'PAGE' PROGRAM

D Armstrong, ¹R Hollingworth, ²T Vienneau, ³W Smith, RH Hunt, ⁴D Leddin

Divisions of Gastroenterology, McMaster University, Hamilton, Ontario & ⁴Dalhousie University, Halifax, Nova Scotia; ¹Credit Valley Hospital, Mississauga, Ontario; ²Isis Digital Media, Burlington, Ontario, ³AstraZeneca Canada, Mississauga, Ontario

BACKGROUND: EGD is an essential part of gastroenterologists' practice; however, the accuracy of endoscopists' pre-test assessment of lesion likelihood is not known.
AIM: To evaluate the prevalence of clinically significant EGD lesions, based on endoscopists' pre-test categorization of lesion likelihood, using a PDA-based, practice audit ('PAGE') program.
METHODS: Endoscopists recorded data at consecutive EGDs over a 3-week period on a PDA (Ipaq, Compaq): indication, expected diagnosis and likelihood of finding a lesion (pre-EGD) and diagnosis, whether biopsy was taken and effect of EGD on management (post-EGD).
RESULTS: To date (31/10/02), 136 endoscopists reported on 4647 EGDs.

After EGD, a change in management was noted for 57.4% of EGDs (21.4% normal) compared with no change for 42.6% of EGDs (43.6% normal); overall, endoscopists noted that they would still have performed the EGD in 93.3% of cases after reviewing the results.
CONCLUSIONS: Endoscopists' pre-test assessment that a 'lesion is very likely' is highly predictive of a lesion at EGD but identification of pre-test predictors and greater use of biopsies may still improve EGD utilization in practice.

Support: CAG and by an unrestricted grant from AstraZeneca Canada.