GI Unit Leadership: Shaping a High-Performing Endoscopy Unit (Virtual)

ASGE open access endoscopy

Pdf Summary

The American Society for Gastrointestinal Endoscopy (ASGE) provides guidelines on open-access endoscopy (OAE), where endoscopic procedures are performed upon referral by physicians without prior clinic consultation. OAE addresses the growing demand for timely endoscopic evaluation, especially for common indications like colorectal cancer screening colonoscopy. The guidelines, based on literature from 1990 to 2015 and expert consensus, aim to assist providers in appropriate use and patient care, not to establish legal standards.<br /><br />OAE is increasingly utilized, with surveys showing widespread adoption and a significant rise in procedure volumes over recent decades. While OAE enhances efficiency and reduces costs related to office visits, it requires that referring physicians understand appropriate indications and communicate them clearly to patients prior to referral. Pertinent medical records must be available to the endoscopist before the procedure.<br /><br />Key issues with OAE include ensuring appropriate referrals, patient readiness and informed consent, diagnostic yield, and follow-up. Studies indicate that most OAE referrals align with ASGE guidelines (over 80% appropriateness), especially when made by gastroenterologists. Inappropriate referrals are more common when made by non-specialists. Patient education prior to OAE improves compliance and satisfaction, and bowel preparation quality for colonoscopy is generally adequate. However, some studies suggest that office consultations may better identify diagnostic needs or improve bowel prep quality.<br /><br />Informed consent obtained on the day of the procedure is acceptable, though OAE patients may have lower understanding of the procedure compared to those seen in clinic. Educational materials and staff involvement can enhance patient knowledge.<br /><br />Diagnostic yield is higher for appropriately indicated procedures, with significantly more clinically relevant findings and malignancies detected when guidelines are followed. Post-procedure, communication of results and management recommendations to both patients and referring providers is essential; most patients do not require further GI consultation after OAE.<br /><br />In summary, OAE is safe and effective if referral appropriateness, patient education, consent, and follow-up communication are ensured. The ASGE recommends that referring providers understand endoscopy indications, discuss them with patients, provide medical records to the endoscopist, and that endoscopy providers complete preprocedure assessments and communicate outcomes.

Keywords

American Society for Gastrointestinal Endoscopy

open-access endoscopy

OAE guidelines

colorectal cancer screening

endoscopic procedures

referral appropriateness

patient education

informed consent

diagnostic yield

post-procedure communication