Abstract
Background and Aims Age cutoff is an important factor in deciding whether esophagogastroduodenoscopy (EGD) is necessary for patients presenting with upper gastrointestinal symptoms. However, the cutoff value is significantly different across populations. We aimed to determine the age cutoff for EGD that assures a low rate of missing upper gastrointestinal malignancy (UGIM) and to assess the yield of prompt EGD in Vietnamese patients presenting with upper gastrointestinal symptoms. Methods All EGDs performed in outpatients during a 6-year period (2014–2019) at a tertiary hospital that provided an open-access endoscopy service were retrospectively reviewed. Repeat or surveillance EGDs were excluded. Different age cutoffs were evaluated in terms of their prediction of the absence of UGIM. The yield of endoscopy to detect one malignancy (YoE) was also calculated. Results Of 472,744 outpatients presenting with upper gastrointestinal symptoms, there were 2198 (0.4%) patients with UGIM. The median age and male-to-female ratio of patients with UGIMs were 57.9 ± 12.5 years and 2.5 : 1, respectively. The YoEs in patients <40, 40–60, and >60 years of age were <1, 1–10, and >10 per 1000 EGDs, respectively. The age cutoffs of 30 years in females and 35 years in males could detect 98.2% (95% CI: 97.7%–98.8%) of UGIM cases with a YoE of about 1 per 1000 EGDs. Conclusions The age cutoff for EGD in Vietnamese should be lower than that recommended by current international guidelines. The strategy of prompt EGD showed a low YoE, and its cost-effectiveness requires further investigation.
Highlights
IntroductionThere are specific guidelines for dyspepsia and gastroesophageal reflux disease, the overlap of symptoms is very common in real-world practice [1]
In patients with confirmed upper gastrointestinal malignancy (UGIM), all followup endoscopies were excluded to obtain the true number of new UGIM cases. e age and sex of all patients were recorded. e endoscopic and histopathologic characteristics of all UGIMs were extracted by trained physicians (Tran L., Tran T., Tran V., and Le N.) according to a predesigned questionnaire. e endoscopic types of esophageal and gastric cancers were reported according to the classifications of the Japanese Esophageal Society and the Japanese Gastric Cancer Association, respectively [14, 15], and the histopathologic findings were reported according to the World Health Organization classification of tumors of the digestive system [16]
Different age cutoffs were evaluated in terms of their prediction of the absence of UGIM. e yield of endoscopy to detect one malignancy per 1000 EGDs (YoE) was calculated. e study protocol conforms to the ethical guidelines of the 1975 Declaration of Helsinki. is study was approved by the Board of Ethics in Biomedical Research of the University of Medicine and Pharmacy at Hochiminh City, Vietnam
Summary
There are specific guidelines for dyspepsia and gastroesophageal reflux disease, the overlap of symptoms is very common in real-world practice [1] All of these guidelines recommend using alarm features to identify patients who have priority for prompt performance of EGD [2,3,4,5]. Age cutoff is an important factor in deciding whether esophagogastroduodenoscopy (EGD) is necessary for patients presenting with upper gastrointestinal symptoms. We aimed to determine the age cutoff for EGD that assures a low rate of missing upper gastrointestinal malignancy (UGIM) and to assess the yield of prompt EGD in Vietnamese patients presenting with upper gastrointestinal symptoms. E age cutoffs of 30 years in females and 35 years in males could detect 98.2% (95% CI: 97.7%–98.8%) of UGIM cases with a YoE of about 1 per 1000 EGDs. Conclusions. Conclusions. e age cutoff for EGD in Vietnamese should be lower than that recommended by current international guidelines. e strategy of prompt EGD showed a low YoE, and its cost-effectiveness requires further investigation
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