ckground and aim: Diagnosis of chronic gastritis is often considered a trivial finding by gastroenterologists. On the contrary, patients and general physicians frequently focus on report of “gastritis” especially if it is severe or associated with metaplastic or atrophic change. Since wrong interpretations or misundestandings could start an inappropriate endoscopic follow up, recent endoscopic guidelines recommend to explicit indications to follow up or not. However we were not sure that in our daily clinical practice an appropriate follow up was prescribed in case of chronic gastritis or the phrase “follow up not required” or similar was all the time reported if appropriated. Material and methods: In 2015 we started an internal AUDIT to analyse our approach to istological diagnosis of chronic gastritis. We retrospectively analysed a series of 464 outpatient upper endoscopies with diagnosis of chronic gastritis performed in 2014 and focused our attention on the follow up prescribed. We analysed also if the phrase “follow up not required” or something similar was present in our final reports. Exclusion criteria are reported in Table 1. Data from 304 procedures resulted fit for statistical analysis. According to AUDIT protocol, four meetings were carried out during 2015. Appropriate indication to chronic gastritis follow up was defined according to ESGE guidelines (Dinis-Ribeiro et al. 2012). In 2016 we prospectively collected 371 outpatient upper endoscopies done after AUDIT meetings. Exclusion criteria were the same of first series. Data from 271 patients resulted fit for analysis. Results are reported in Table 2. Results: Our data show that some kind of gastritis is present in 85–90% of patients submitted to gastric biopsy, but only a minority of them need endoscopic follow up. Retrospective analysis of our daily activity confirmed sensation that diagnosis of chronic gastritis often was not accompanied by appropriate definition of follow up. AUDIT approach was able to reduce follow up omissis from 53% to 12% (p<005) and inappropriate “not follow up is required” from 1.4% to 0.4% (: NS) but was less able to reduce prescription of inappropriate “follow up is required” (from 63% to 47%, : NS). Finally, prescription of follow up for chronic gastritis decreases from 7.5% to 6% (: NS). Conclusions: Our analysis demonstrates that histological gastritis is potentially not a trivial finding in clinical practice. AUDIT methodology can improve appropriate approach to chronic gastritis and could reduce inappropriate upper endoscopy use in clinical practice. However, further efforts are necessary to ameliorate appropriate prescription of follow up in this setting
Fabbri, C., Giovanelli, S., Gibiino, G., Fornelli, A., De Biase, D., Jovine, E., et al. (2017). EUS-GUIDED TISSUE ACQUISITION WITH 20-GAUGE PROCORE NEEDLE AND "WET" TECHNIQUE 19-GAUGE FLEX FNA IN SOLID PANCREATIC AND NON-PANCREATIC MASSES - A SINGLE CENTRE EXPERIENCE. DIGESTIVE AND LIVER DISEASE, 49, E87-E88 [10.1016/S1590-8658(17)30322-5].
EUS-GUIDED TISSUE ACQUISITION WITH 20-GAUGE PROCORE NEEDLE AND "WET" TECHNIQUE 19-GAUGE FLEX FNA IN SOLID PANCREATIC AND NON-PANCREATIC MASSES - A SINGLE CENTRE EXPERIENCE
Fabbri, C;De Biase, D;Jovine, E;
2017
Abstract
ckground and aim: Diagnosis of chronic gastritis is often considered a trivial finding by gastroenterologists. On the contrary, patients and general physicians frequently focus on report of “gastritis” especially if it is severe or associated with metaplastic or atrophic change. Since wrong interpretations or misundestandings could start an inappropriate endoscopic follow up, recent endoscopic guidelines recommend to explicit indications to follow up or not. However we were not sure that in our daily clinical practice an appropriate follow up was prescribed in case of chronic gastritis or the phrase “follow up not required” or similar was all the time reported if appropriated. Material and methods: In 2015 we started an internal AUDIT to analyse our approach to istological diagnosis of chronic gastritis. We retrospectively analysed a series of 464 outpatient upper endoscopies with diagnosis of chronic gastritis performed in 2014 and focused our attention on the follow up prescribed. We analysed also if the phrase “follow up not required” or something similar was present in our final reports. Exclusion criteria are reported in Table 1. Data from 304 procedures resulted fit for statistical analysis. According to AUDIT protocol, four meetings were carried out during 2015. Appropriate indication to chronic gastritis follow up was defined according to ESGE guidelines (Dinis-Ribeiro et al. 2012). In 2016 we prospectively collected 371 outpatient upper endoscopies done after AUDIT meetings. Exclusion criteria were the same of first series. Data from 271 patients resulted fit for analysis. Results are reported in Table 2. Results: Our data show that some kind of gastritis is present in 85–90% of patients submitted to gastric biopsy, but only a minority of them need endoscopic follow up. Retrospective analysis of our daily activity confirmed sensation that diagnosis of chronic gastritis often was not accompanied by appropriate definition of follow up. AUDIT approach was able to reduce follow up omissis from 53% to 12% (p<005) and inappropriate “not follow up is required” from 1.4% to 0.4% (: NS) but was less able to reduce prescription of inappropriate “follow up is required” (from 63% to 47%, : NS). Finally, prescription of follow up for chronic gastritis decreases from 7.5% to 6% (: NS). Conclusions: Our analysis demonstrates that histological gastritis is potentially not a trivial finding in clinical practice. AUDIT methodology can improve appropriate approach to chronic gastritis and could reduce inappropriate upper endoscopy use in clinical practice. However, further efforts are necessary to ameliorate appropriate prescription of follow up in this settingI documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
