We agree with Pickover's concern about the frequent performance of nonindicated procedures recently reported in our study of open-access endoscopy.1 We found the rates of inappropriate indications for esophagogastroduodenoscopy and colonoscopy to be 3% and 15%, respectively, for patients referred by primary care physicians compared with 19% and 33%, for patients referred by non—primary care physicians. Open-access referrals from non—primary care physicians constituted only 17% of all open-access referrals.
We disagree, however, with Pickover's solution to this problem. Having all patients who need endoscopic procedures see a gastroenterologist before the procedure is no guarantee that the performed procedure will be indicated. For instance, a recent study2 found that 20% of esophagogastroduodenoscopies performed by a private practice gastroenterology group were not indicated.
Also, open-access endoscopy is not likely to disappear. We recently conducted a national survey of members of the American Society for Gastrointestinal Endoscopy, the results of which we