APPROPRIATENESS ASGE CRITERIA FOR ERCP. A MULTICENTER STUDY

Background and aim: The evaluation of appropriateness and diagnostic yeld of endoscopic procedures is critical when assessing the costs and benefits of endoscopy.The aims of this prospective study were: i) to examine the appropriate use of Endoscopic Retrograde Cholangio-Pacreatography (ERCP) in 3 Italian Academic Center using the American Society of Gastrointestinal Endoscopy (ASGE) guidelines; ii) to verify whether the ASGE guidelines were associated with the endoscopic demonstration of serious diseases. Material and methods: In a cohort of 429 consecutive patients (m/f 187/242), mean age 70 yrs,range 16-99) referred for ERCP to three University-based Italian Endoscopic Services, the percentage of patients who underwent ERCP for appropriate and inappropriate indications, was prospectively assesed. The relationship between appropriateness of use and the presence of relevant endoscopic lesions (neoplasms, biliary duct stones, stenosis, pancreatitis, biliary fistula, cholangitis) was assesed calculating the likelihood ratio (positive, LR+ and negative, LR-). Results: The rate of ERCP generally not indicated (according to the ASGE guidelines) was 3.5%. Comparison between patients with ASGE indications and those without indications: ASGE non-ASGE Normal ERCP: 9% 23% p<0.05 Relevant Disease: 88% 77% p<0.05 The likelihood ratio (LR) for finding a relevant endoscopic disease was: LR+ LRPresence of ASGE Guidelines 1.26 0.44 Non-ASGE Indications 0.44 1.26 Conclusions: The use of appropriate indications can improve patients selection for ERCP, and thus can contribute to efforts aimed at enhancing the quality and efficiency of care. However in order to avoid to miss some serious diseases, this must be taylored to the specific clinical setting where the guidelines has to be applied.