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Intern Emerg Med. 2019 Mar;14(2):301-308. doi: 10.1007/s11739-018-1992-x. Epub 2018 Nov 29.

Five common errors to avoid in clinical practice: the Italian Association of Hospital Gastroenterologists and Endoscopists (AIGO) Choosing Wisely Campaign.

Author information

1
Gastroenterology Unit, National Institute of Gastroenterology "S. De Bellis" Research Hospital, Via Turi 27, 70013, Castellana Grotte, Ba, Italy. elisa.stasi@irccsdebellis.it.
2
Gastroenterology and Digestive Endoscopy Unit, Ospedale Santa Chiara, Trento, Italy.
3
Gastroenterology Unit, Ospedali Riuniti Villa Sofia-Vincenzo Cervello, Palermo, Italy.
4
Gastroenterology Unit, San Giuseppe Hospital, Empoli, Italy.
5
Gastroenterology Unit, AOU Città della Salute e della Scienza Turin, Turin, Italy.
6
Gastroenterology Unit, ULSS 12, Venice, Italy.
7
Gastroenterology Unit, AUSL Romagna, Ravenna, Italy.
8
Gastroenterology Unit, San Carlo Borromeo Hospital, Milan, Italy.
9
Gastroenterology Unit, National Institute of Gastroenterology "S. De Bellis" Research Hospital, Via Turi 27, 70013, Castellana Grotte, Ba, Italy.
10
Department of Medicine, Ospedale Vittorio Emanuele III, Salemi, Tp, Italy.
11
Digestive Endoscopy Unit, Humanitas Research Hospital, Milan, Italy.

Abstract

Modern medicine provides almost infinite diagnostic and therapeutic possibilities if compared to the past. As a result, patients undergo a multiplication of tests and therapies, which in turn may trigger further tests, often based on physicians' attitudes or beliefs, which are not always evidence-based. The Italian Association of Hospital Gastroenterologists and Endoscopists (AIGO) adhered to the Choosing Wisely Campaign to promote an informed, evidence-based approach to gastroenterological problems. The aim of this article is to report the five recommendations of the AIGO Choosing Wisely Campaign, and the process used to develop them. The AIGO members' suggestions regarding inappropriate practices/interventions were collected. One hundred and twenty-one items were identified. Among these, five items were selected and five recommendations were developed. The five recommendations developed were: (1) Do not request a fecal occult blood test outside the colorectal cancer screening programme; (2) Do not repeat surveillance colonoscopy for polyps, after a quality colonoscopy, before the interval suggested by the gastroenterologist on the colonoscopy report, or based on the polyp histology report; (3) Do not repeat esophagogastroduodenoscopy in patients with reflux symptoms, with or without hiatal hernia, in the absence of different symptoms or alarm symptoms; (4) Do not repeat abdominal ultrasound in asymptomatic patients with small hepatic haemangiomas (diameter < 3 cm) once the diagnosis has been established conclusively; (5) Do not routinely prescribe proton pump inhibitors within the context of steroid use or long-term in patients with functional dyspepsia. AIGO adhered to the Choosing Wisely Campaign and developed five recommendations. Further studies are needed to assess the impact of these recommendations in clinical practice with regards to clinical outcome and cost-effectiveness.

KEYWORDS:

Appropriateness; Choosing wisely; Overdiagnosis; Overtreatment; Recommendations

PMID:
30499071
DOI:
10.1007/s11739-018-1992-x

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