Factors Associated with the Applicability of EPAGE (European Panel on the Appropriateness of Gastrointestinal Endoscopy) and the Suitability of Indications for Eso-Gastroduodenal Endoscopy in a West African Country

Abstract

Background: EGDF’s reference examination for exploring the digestive tract has seen steadily increasing demands over the past few years. The exam can be expensive and often poorly tolerated. Its prescription must take the cost/be - nefit and its relevance into account. The EPAGE criteria were developed to allow the appropriate selection of endoscopic procedures. Objective: To determine the factors associated with the applicability and appropriateness of the EGDF indications by the EPAGE criteria in our context in order to limit the number of inadequate EGDFs. Material and Method: Prospective cross- sectional study on the applicability of EPAGE (European Panel on the Appropriateness of Gastrointestinal Endoscopy) and the relevance of the indications for Eso-Gastro-Duodenal Fibroscopy (EGDF) according to the criteria of the EPAGE in two large public hospitals located in the central region of Ivory Coast over a period of 8 months from September 2019 to May 2020 . The following parameters (age, sex, history and comorbidities of the patient, the indication of EGDF, the qualification of the prescriber, the EPAGE situation, the relevance of the indications according to EPAGE, the result of the EGDF) were collated classified into judgment criteria and analyzed via the site https://www.epage.ch/ depending on whether the indication was appropriate, uncertain or inappropriate. The difference was significant for a value of p ≤ 0.05. Results: This was 1010 EGDF. The indications for EGDF were epigastralgia, gastrointestinal haemorrhage, testing for PHT signs, heartburn, vomiting, dysphagia, chest pain, anemia, control, tumor assess ment. The result of EGDF was normal (14.9%), non-significant lesions (47.5%) and significant lesions (37.6%). EPAGE was applicable in 93.8% of patients, and the indications for EGDF were considered appropriate in 54.2% of cases. The EPAGE criteria were significantly applicable and appropriate in cases of epigastralgia, digestive haemorrhage, heartburn, and vomiting but not applicable for the search for signs of PH, for non-significant lesions and for 1/3 of gastric cancer. Significant lesions predominated in patients with appropriate indications (p < 0.001), whereas some significant lesions had uncertain indications. Conclusion: In our context, the EPAGE criteria could constitute a useful tool for the diagnostic profitability of EGDF. The indications deemed appropriate are statically associated with significant lesions and advanced age. But EPAGE must be adapted to our indications and cannot replace the reasoning of the practitioner when faced with the suspicion of significant lesions.