FOR THE APPROPRIATE USE OF UPPER DIGESTIVE ENDOSCOPY ARE ASGE CRITERIA MORE ACCURATE THAN EPAGE METHOD?

Purpose: The aim of this study was to compare the diagnostic performance (expressed as the accuracy in detecting relevant pathologies) of two systems for the evaluation of the appropriateness of upper digestive endoscopy suggested by the American Society of Gastrointestinal Endoscopy (ASGE) and by the European Panel on the Appropriateness of Gastrointestinal Endoscopy (EPAGE). Methods: Patients referred for upper digestive endoscopy (EGD) to a University outpatients Clinic of North-eastern Italy, were consecutively included in this prospective observational study. Before the procedure was performed the endoscopist assigned the patients to one of the ASGE appropriateness class; afterwards another endoscopist, without prior knowledge of the result of ASGE assignment, identified the detailed clinical scenario for the patients, which correspond to scenarios examined by EPAGE (see www.epage.ch), by using a 9-point scale: 1–3 inappropriate; 4–6 uncertain; 7–9 appropriate. The relationship between appropriateness of use and the presence of relevant endoscopic lesions (neoplasms, ulcers, esophagitis, erosive gastritis/duodenitis, stenosis, varices) was assessed, calculating the sensitivity and the specificity for each of the ASGE criteria, and each of the EPAGE score. Each couple of sensitivity/specificity data was plotted to form a so-called ROC curve. The area under the ROC curve (AUC) provides a summary measure of test performance, and can vary from 0.5 for a useless test to 1.0 for a very accurate test. We compared the AUC (and 95%CI) of the ROC curve derived from the application of ASGE criteria against that derived from the application of the EPAGE criteria. Results: Two thousand three hundred consecutive patients were included in the study (42% men; mean age 57.3; range 12–99); comparison of appropriateness criteria according to ASGE and EPAGE could be made for 2000 patients. The AUC of the ROC curve derived from the ASGE criteria was 0.553 (95%CI: 0.527–0.579), significantly higher than the AUC of the ROC curve derived from the EPAGE score that was 0.523 (95%CI: 0.497–0.549. p0.05). Conclusions: On the basis of our results we can suggest that the diagnostic accuracy for relevant pathologies obtained by both systems (ASGE and EPAGE) is unsatisfactory; slightly better results could be accomplished by ASGE criteria than by EPAGE method.