Prospective comparative study of open access endoscopy versus conventional practice

Purpose: To determine the feasibility of open access endoscopy and to compare its outcome to that of conventional practice. Methods: All written elective gastroenterology consultation requests were reviewed daily and requests with at least one valid indication for endoscopy were directly scheduled for the procedure without a clinic visit, by open access. No attempt was made to modify or 'censor' the consultation requests and no additional information (e.g., chart review, telephone interview, etc) was used in the decision to schedule patients for open access endoscopy. All other patients were seen first in clinic and patients with valid indications for endoscopy were scheduled for the procedure electively. outcomes were prospectively collected and compared. Results: A total of 348 consultations requests were received during a 10 week period. Indications for consultation included upper and lower gastrointestinal tract problems (123 and 102 cases, respectively), hepatology (50), screening sigmoidoscopy (42), and others (31). Of the 225 patients with luminal gastrointestinal problems, 76 (34%) were scheduled for endoscopy based solely on the brief consultation requests, by the open access approach. Forty two (19%) additional patients were scheduled to undergo endoscopy after a full preprocedure clinic visit, using the conventional approach. The mean ages (61 vs 55 y), gender distributions (48% vs 47% men), and the proportions of patients who did not keep the appointment or rescheduled (18% vs 14%) were similar between the two groups, but open access patients underwent endoscopy significantly earlier compared to conventional patients (14.7 vs 37.1 d). The positive yield of endoscopy (60% vs 70%) and prevalence of therapy (27% vs 30%) were similar between the patients who underwent endoscopy by the open access or conventional approach. There were no complications. No procedure was canceled because of improper indication or medical instability of the patient. Approximately a half of the open access patients who were contacted by telephone after 30 days were satisfied with the open access system. Conclusions: These data suggested that open access endoscopy could decrease the waiting time for endoscopy to less than half of the conventional approach, without adversely effecting the clinical outcomes.