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The SGI Panel Is Frequently Used by Non-Gastroenterologists to Diagnose Inflammatory Bowel Disease
Berinstein J, Higgins PD, Waljee AK, Stidham RW, Govani SM. The SGI Panel Is Frequently Used by Non-Gastroenterologists to Diagnose Inflammatory Bowel Disease. Poster session presented at: Digestive Disease Week Annual Conference; 2016 May 22; San Diego, CA.
Title: The SGI Panel Is Frequently Used by Non-Gastroenterologists to Diagnose Inflammatory Bowel Disease
Authors: Jeffrey Berinstein, Peter D.R. Higgins, Akbar K. Waljee, Ryan W. Stidham, Shail M. Govani
Background and Aims: Inflammatory bowel diseases (IBD) are diagnosed using a combination of history, radiology, endoscopy and pathology. In some instances, the diagnosis of IBD or the phenotype, Crohn's disease and ulcerative colitis (UC), remains unclear. In cases of diagnostic uncertainty, the SGI panel (Prometheus) can provide some clarity. Our aim was to study how this test was being used with a particular focus on the type of providers obtaining the testing and whether the test was ordered prior to endoscopy or afterwards.
Methods: We conducted a retrospective review looking for patients who had the SGI panel sent between 1/1/2011 and 6/30/2015 at a large tertiary care center in the United States. We identified the ordering provider, timing of the test, diagnosis before and after testing and the test result. We characterized the ordering provider as a gastroenterologist (GI) or non-gastroenterologist. For tests obtained in the hospital setting, the test was attributed to GI if a GI consulting team was following the patient. Timing of testing was characterized as either before or after endoscopy. The results of the SGI test were compared to the final clinical diagnosis among those patients who had an endoscopy. Chi-square testing was used to make comparisons using SAS 9.4.
Results: During the study period, 190 SGI tests were obtained. Sixty-five percent of the patients were female and the average age was 39.7 years (+/- 15.1). In 59.5% of the cases, the ordering service was GI. The most prevalent non-GI service to obtain the test was rheumatology (25.8% of all tests). Forty percent of tests were obtained before the patient underwent endoscopy and 22.6% of patients never underwent an endoscopy after testing. The SGI test results were not suggestive of IBD in 44.9% of cases who underwent endoscopy while the clinical diagnosis after endoscopy and SGI testing was not consistent with IBD in 57.8% of cases. The negative predictive value of the test was 75.8%; the positive predictive value was only 56.8%. The agreement between the test result and the final clinical diagnosis was 65.3%. The test results were more likely to be negative if ordered by non-GI versus GI (63.6% vs. 44.3% respectively, p < 0.01). There was no significant difference in agreement rates in tests ordered by GI versus non-GI (63.6% vs. 68.8% respectively, p = 0.54).
Conclusions: The SGI panel is ordered by non-GI providers frequently, with a significant portion obtained prior to a routine endoscopic evaluation. In a single tertiary care cohort, the negative predictive value was 75.8% while the positive predictive value was poor. The test was accurate in differentiating IBD from non-IBD 65.3% of the time. More studies are needed to understand the value of this test in the real world setting.