Journal
GASTROENTEROLOGY
Volume 154, Issue 7, Pages 1993-2003Publisher
W B SAUNDERS CO-ELSEVIER INC
DOI: 10.1053/j.gastro.2017.12.044
Keywords
Gastrointestinal Endoscopy; Utilization; Colorectal Cancer Screening; Barrett's Esophagus
Categories
Funding
- Medtronic
- CSA Medical
- C2 Therapeutics
- Boston Scientific
- CDx Medical
- Fujifilm
- Pentax Endoscopy
- Fractyl Medical
- Cernostics
- Interpace
- Erbe Medical
- NinePoint Medical
- Apollo
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A substantial literature documents inappropriate usage of gastrointestinal endoscopy in a variety of clinical settings. Overusage of endoscopy appears to be common, and 30% or more of procedures performed in some clinical settings have questionable indications. The potential reasons for overuse of endoscopy are multiple, and include cancer phobia, fear of medical malpractice litigation, profit motive, the investigation of incidentalomas found on other imaging, and underappreciation of the delayed harms of endoscopy, among other reasons. Clinical guidelines, which should limit overuse of endoscopy, may instead serve to promote it, if authors opt to be conservative, recommending endoscopy in situations of unclear utility. Several strategies may decrease overuse of endoscopy, including careful attention to risk stratification when choosing patients to screen, adherence to guidelines for surveillance intervals for colonoscopy, the use of quality indicators to identify outliers in endoscopy utilization, and education on appropriate indications and the risks of overuse at the medical student, residency, and fellowship levels.
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