Diagnostic Yield Of Upper Endoscopy Research Articles

Diagnostic yield of endoscopy in irritable bowel syndrome: A nationwide prevalence study 1987–2016

Introduction: Symptoms of irritable bowel syndrome (IBS) are common reasons for endoscopic procedures. We examined the yield of colonoscopy and upper endoscopy in IBS for several organic diseases. Methods: Matched population-based prevalence study in Sweden. We identified 21,944 participants diagnosed with IBS from 1987 to 2016 undergoing colonoscopy with a biopsy from all of Sweden's 28 pathology departments within 6 months of diagnosis. We compared prevalence of histopathology-proven diagnoses of inflammatory bowel disease (IBD), colorectal cancer, precancerous polyps, and microscopic colitis between patients recently diagnosed with IBS and matched controls without IBS (n = 81,101) undergoing colonoscopy. We also compared prevalence of celiac disease between patients diagnosed with IBS (n = 9,965) and matched controls (n = 45,584) undergoing upper endoscopy with biopsy. IBS patients were also compared to their siblings. Conditioned logistic regression estimated adjusted odds ratios (aORs). Results: Biopsy-proven IBD was seen in 1.6% of IBS and in 5.9% of controls (aOR=0.21; 95%CI=0.19–0.24). The prevalence of precancerous polyps was 4.1% vs. 13.0% (aOR=0.28; 95%CI=0.26–0.30), colorectal cancer 0.8% vs. 6.3% (aOR=0.17; 95%CI=0.14–0.20) and celiac disease 1.9% vs. 3.4% (aOR=0.54; 95%CI=0.47–0.63). Conversely, the prevalence of microscopic colitis was 2.9% vs. 1.7% (aOR=1.77; 95%CI=1.61–1.95), with higher prevalence in older patients and patients with IBS with diarrhea. Yield of colonoscopy for precancerous polyps, colorectal cancer, and microscopic colitis increased by age. Our findings were consistent using unaffected siblings as the comparator group. Discussion: The diagnostic yield of upper endoscopy and colonoscopy for organic disease is low in patients with a first-time diagnosis of IBS, though increases with age.

The Utilization and Diagnostic Yield of Upper Endoscopy for Evaluation of Gastrointestinal Symptoms Within the First Year After Liver Transplantation

BackgroundGastrointestinal (GI) symptoms impact quality of life and increase health care utilization after liver transplantation (LTx). Esophagogastroduodenoscopy (EGD) is commonly used to investigate these symptoms.AimsThe aim of this study was to investigate the diagnostic yield and utilization of EGD after LTx for common GI symptoms.MethodsThis single-center retrospective cohort study was conducted at a large liver transplant center and included all adults who underwent EGD within the first year after receiving LTx between January 1, 2015, and December 31, 2016. Biliary procedures were excluded.ResultsOf 437 patients who underwent LTx during the study period, 64 (15%) underwent EGD for the evaluation of GI symptoms within the first year of transplantation. After applying exclusion criteria, 57 (13%) cases were analyzed. GI hemorrhage (hematemesis/melena) was the most common reason (4%; n=18) for evaluation with EGD followed by nausea/anorexia (3%; n=12). Symptoms were investigated with EGD, including epigastric/abdominal pain (2%; n=9), dysphagia/odynophagia (2%; n=8), anemia (1%; n=5), diarrhea (1%; n=4), and heartburn (0.2%; n=1). The diagnostic yield of EGD was highest with GI hemorrhage (83%) followed by dysphagia/odynophagia (75%). EGD diagnostic yield was lower for the other symptoms, ranging from 0% to 25%.ConclusionsEGD was commonly utilized within the first year of LTx, with the highest diagnostic yields for GI hemorrhage and dysphagia/odynophagia. Because of the low diagnostic yield of EGD for other symptoms, we recommend a careful selection of patients for EGD following LTx.

Evaluation of Upper Endoscopic and Endoscopic Ultrasound Features in the Differential Diagnosis of Gastrointestinal Stromal Tumors and Leiomyomas in the Upper Gastrointestinal Tract

Background: Differentiation between benign and malignant subepithelial lesions (SELs) in the upper gastrointestinal tract (UGT) leads to far-reaching clinical consequences. An accurate diagnosis can be challenging because of the insufficient diagnostic yield of upper endoscopy, endoscopic ultrasound (EUS), and different types of biopsy. Aim: Our aim was to reveal the efficacy of upper endoscopic and EUS features for the differential diagnosis of hypoechogenic SELs (gastrointestinal stromal tumors [GISTs] and leiomyomas) in the UGT. Materials and Methods: The research covers a case series study of 27 hypoechogenic SELs in the UGT between 2012 and 2015 at Vilnius University Hospital Santaros Klinikos. Upper endoscopic and EUS features of SELs were recorded. In order to standardize the diagnostic approach to GISTs and leiomyomas, we assigned scores for seven upper endoscopic and EUS features. Results: The mean total scores in the GIST group were significantly higher than those in the leiomyoma group: 3.25 ± 1.71 and 0.53 ± 0.83 (p < 0.0001), respectively. Increment by one score increased the odds ratio for GIST 5.87 times (95% CI 1.63–21.11; p = 0.007). The total score demonstrated very good discriminatory features of GISTs against leiomyomas (area under the receiver operating characteristic curve 0.94 [0.86–1]). The cutoff value of 1.5 total score indicated 83.3% sensitivity and 93.3% specificity in diagnosing GISTs. Conclusions: Upper endoscopy and EUS are useful methods in making a definite diagnosis of SELs. Their diagnostic accuracy for the differential diagnosis of GISTs and leiomyomas is sufficient.

Sa1793 - Diagnostic Yield of Upper Endoscopy and Improvement of the Diagnostic Workup Based by Porto Criteria: Results of the Hungarian Prospective Nationwide Pediatric IBD Registry (Hupir)

Sa1793 - Diagnostic Yield of Upper Endoscopy and Improvement of the Diagnostic Workup Based by Porto Criteria: Results of the Hungarian Prospective Nationwide Pediatric IBD Registry (Hupir)

The Utilization and Diagnostic Yield of Upper Endoscopy for Evaluation of Gastrointestinal Symptoms Within 1-Year After Liver Transplantation

The Utilization and Diagnostic Yield of Upper Endoscopy for Evaluation of Gastrointestinal Symptoms Within 1-Year After Liver Transplantation

Yield of Endoscopy in Pediatric Gastroparesis.

The aim of the study was to quantify the diagnostic yield of upper endoscopy in children with gastroparesis and to develop a clinical model for gastroparesis using common symptoms and screening blood tests. We retrospectively reviewed charts of 196 patients of age 4 to 18 years evaluated for gastroparesis between 2009 and 2013. All patients completed a standard solid-phase gastric emptying scan and upper endoscopy within a 12-month period. We analyzed gross and histologic endoscopy findings. Symptom-based data were collected on dyspeptic symptoms and classic "red-flag" symptoms. Seventy patients with gastroparesis and 126 controls were included. Clinically significant endoscopic findings were noted in 35% of controls (44/126) and 43% of gastroparetics (30/70), P = 0.345. Concordance between gross and histologic findings was low at 50%. Histologic findings included gastritis 60% (17/28), esophagitis 39% (11/28), and duodenitis 7% (2/28). In univariate and multivariate analyses, there was no meaningful correlation between symptoms and/or screening laboratory values and diagnosis of gastroparesis. Clinically significant endoscopy findings were common in both controls and gastroparetics. As more than one-third of patients had findings on endoscopy, we conclude that upper endoscopy remains an important part of the evaluation process of patients with dyspeptic symptoms and suspected gastroparesis. As gross abnormalities were frequently not present with histologic changes, routine biopsy is required. There was no association between studied symptoms and the presence of gastroparesis. A comprehensive evaluation of children with dyspeptic symptoms requires endoscopy with biopsy and solid-phase gastric emptying scan to determine the underlying diagnosis.

Diagnostic Yield of Upper Endoscopy and Colonoscopy for Isolated Unintentional Weight Loss

Introduction: Unintentional weight loss is a symptom that concerns physicians because of its association with increased mortality.The diagnostic evaluation of unintentional weight loss (UWL) often includes endoscopic procedures when gastrointestinal symptoms are present. In the absence of alarm features such as vomiting, dysphagia and gastrointestinal bleeding, the diagnostic yield of endoscopic evaluation is poorly defined. AIMS: The primary aim of this study is to investigate the diagnostic yield of upper endoscopy and colonoscopy in patients with isolated, unintentional weight loss. The secondary aim of this study was to investigate the diagnostic yield of upper endoscopy and colonoscopy particularly in adults over age 65. Methods: A retrospective, cross-sectional analysis was performed using the electronic medical record at an academic gastroenterology practice from January 2009 to December 2013.The study sample included patients referred for endoscopic evaluation with an associated ICD-9 code for unintentional weight loss. Chart review was performed to abstract demographic and clinical data including age, sex, race, and clinical symptoms. The primary outcome was clinically significant abnormal endoscopic findings such as peptic ulcer, gastrointestinal malignancy, esophageal stricture, or colitis. Clinically significant weight loss was defined as greater than 5% of baseline body weight loss in kilograms in the 6 months preceding the endoscopic procedure.Statistical analysis was performed using Pearson’s chi-squared test in STATA IC 13.0 statistical software. Results: Of the 300 records initially identified, 140 where excluded. The final sample size was 160. The study sample was 63% female and 49% White. Median age was 61.2 years (SD 17.7). The mean percent baseline body weight loss was 9.69% (SD 6.19). The laboratory evaluation and imaging was normal in 98% (157) of patients. Upper endoscopy findings where clinically insignificant in 97% (155) of the study sample. Colonoscopy findings where clinically insignificant in 96% (153) of the study sample.In those > age 65 versus <65, there was no statistically significant difference in the frequency of clinically significant upper endoscopic (1.5% vs 1.63%; p=0.12) or colonoscopic findings (2.60.% vs 1.62%; p= 0.09). Conclusion: In this study, the diagnostic yield of upper endoscopy and colonoscopy was low in patients presenting with isolated unintentional weight loss in the setting of normal laboratory and imaging evaluation. Furthermore, individuals over age 65 did not have a significantly higher frequency of clinically significant endoscopic findings compared with those under age 65. This research was supported by an industry grant from “This project was supported by Grant Number UL1TR000003 from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH). The content is solely the responsibility of the authors and does not necessarily represent the official view of NCATS or the NIH.

Su1740 The Diagnostic Yield of Upper Endoscopy in Children: Do Symptoms Matter?

prospective data collection using a standard computerized report generator and central registry (PEDS-CORI) to examine factors affecting examination of the ileum during colonoscopies performed in 14 pediatric centers between Jan 2000 and Dec 2011. Procedures with and without examination of the ileum were compared with regards to demographic and clinical features in practices with more than 100 colonoscopy procedures during the study period. Results: We analyzed 21, 807 colonoscopy procedures performed in patients with mean age of 11.9 (SD 4.8). Overall, 15,130 (69%) of colonoscopies included examination of the ileum. Patients in which the ileum was not examined were younger, had higher ASA class, and were more likely to have procedures performed under intravenous sedation. Procedures done under general anesthesia were associated with intubation rate of 76%, while other sedation types (intravenous sedation) had a significantly lower intubation rate of 63% ( p!0.001). Procedures done in male patients achieved an intubation rate of 68%, significantly lower than the 71% rate seen in female patients ( p!0.001). The presence of a fellow was not associated with ileal intubation (pZ0.072). Colonoscopies done with an adequate bowel prep reported a higher rate of intubation than those without (94% vs. 82%; p!0.001). Of the 21, 807 reports received during the study period, 56% did not document bowel prep quality, 31% did not include duration of procedure, and 12.7% did not include ASA classification. Conclusions: Approximately, 30% of colonoscopy procedures in children did not include complete examination (i.e., reach the ileum). Several factors including age, sedation method, ASA class, and quality of bowel prep are associated with examination of the terminal ileum during colonoscopy in children. Su1740 The Diagnostic Yield of Upper Endoscopy in Children: Do Symptoms Matter? Barra Alabd Alrazzak, Deborah Preston, Yoram Elitsur* Pediatrics, Gastroenterology, Marshall University, Huntington, WV; Pediatrics, Gastroenterology, Marshall University, Huntington, WV Introduction: Upper endoscopic (EGD) procedure in children is a common diagnostic tool for children with various abdominal symptoms. The diagnostic value of EGD in regards to positive histology and its association with symptoms has not been adequately investigated. Previous reports suggested that in up to 62% of diagnostic EGD, no histologic abnormalities are found. (Hyams JS. JPGN 2000). Aim: to evaluate the correlation between symptoms and histology in children who undergo the first diagnostic upper endoscopy procedure at our gastroenterology clinic. Method: A retrospective chart review of all children who had their first diagnostic upper endoscopy procedure, between 2006 and 2011, was performed. Demographic, clinical symptoms and histology were collected. Mucosal biopsies from the esophagus, stomach and small intestine were available in all patients irrespective of the tissue appearance. Children with the diagnosis of chronic recurrent abdominal pain were excluded from the study. Results: A total of 728 endoscopy charts were reviewed. Male/Female ratio and mean age were 1.12:1.0, and 11.5 years, respectively. The most common presenting symptom in our cohort was abdominal pain (64%) followed by N&V (23%), FTT (6.4%), GI bleed (6%), and dysphagia (5.6%). The most common pathologic finding was gastritis (56%) followed by esophagitis (37%), duodenitis (11%), EoE (10%), and H. pylori-associated gastritis (2%) (Table 1). In 260 (36%) procedures, no pathology was found in either of the organs (esophagus, stomach, duodenum). The sensitivity and specificity to detect mucosal pathology for any symptom ranged between 5668% and 3440%, respectively, with no significant differences among the symptoms (Table 2). Conclusion: In over a third of our EGD’s no mucosal pathology was found. The accuracy rate to detect pathology was approximately 80% for abdominal pain but was below 50% for all other presenting symptoms. With increasing cost of endoscopic procedures, calculation of cost analysis is needed in order to assess the diagnostic yield of this procedure in children with various GI symptoms. Table 1. Presenting symptoms and histology

Tu1383 What Is the Diagnostic Yield of Upper Endoscopy in Symptomatic Patients With Systemic Sclerosis?

Tu1383 What Is the Diagnostic Yield of Upper Endoscopy in Symptomatic Patients With Systemic Sclerosis?

Tu1309 Diagnostic Yield of Upper Endoscopy in the Initial Evaluation of Esophageal Dysphagia

Tu1309 Diagnostic Yield of Upper Endoscopy in the Initial Evaluation of Esophageal Dysphagia

Diagnostic Yield of Upper Endoscopy Followed by Impedance-pH Monitoring in PPI-refractory GERD Patients with Typical Symptoms

Diagnostic Yield of Upper Endoscopy Followed by Impedance-pH Monitoring in PPI-refractory GERD Patients with Typical Symptoms

Diagnostic yield of upper endoscopy in paediatric patients with Crohn's disease and ulcerative colitis. Subanalysis of the HUPIR registry

Background, aims According to Porto Criteria upper gastrointestinal (UGI) endoscopy is recommended in patients with suspected inflammatory bowel disease (IBD). Nevertheless, previous studies revealed frequent involvement of UGI tract even in patients with ulcerative colitis (UC). The aim of the present study was to determine the diagnostic role of esophagogastroduodenoscopy (EGD) and assess the prevalence and different aspects of UGI involvement in children registered in the Hungarian Pediatric IBD Registry (HUPIR) from 1st of January 2007 to 31th of December 2009. Methods Twenty seven institutes provided prospective follow-up data about newly diagnosed IBD patients to HUPIR. The registry was based on detailed questionnaire (76 parameters) involving anamnestic data, laboratory findings, activity indexes, diagnostic procedures, endoscopic examinations (EGD and ileocolonoscopy), and histological data. Localization and phenotype of disease were based on the Montreal classification criteria. Results During the 3-year period 420 children were diagnosed with IBD, 265 (63%) of them had Crohn's disease (CD), 130 (31%) UC, and 25 (6%) IBD-unclassified (IBD-U). The mean age at diagnosis was 13.2 years (range: 1.2–18 years). EGD was performed in 237 patients (56%), in most cases in patients suffering from CD. Macroscopic lesions on EGD were noted in 64% of patients with CD and 40% of children with UC. Characteristic lesions for CD (ulcer, erosion, aphthous lesion, and granuloma) were noted in 31% of CD patients, however, EGD helped to establish the final diagnosis in 9% of CD patients (diagnostic yield, 9%). Conclusions There was a high frequency of UGI involvement in children with CD and UC. One third of CD patients showed significant lesions at upper endoscopy and one patient out of ten had real diagnostic help from EGD.

Diagnostic Yield of Upper Endoscopy in Transplant Recipients

Diagnostic Yield of Upper Endoscopy in Transplant Recipients

Impact of Pediatric Rome III Criteria of Functional Dyspepsia on the Diagnostic Yield of Upper Endoscopy and Predictors for a Positive Endoscopic Finding

Pediatric Rome III criteria of functional dyspepsia (FD) has eliminated the mandatory use of upper endoscopy and recommended a symptom-based approach. In the absence of alarm symptoms, FD can be positively diagnosed in children having normal physical findings without exclusionary investigations. We aimed to investigate the effectiveness of Rome III guidelines to discriminate organic diseases from FD and to identify the predictors for positive endoscopic findings. A prospective study was conducted on consecutive children fulfilling Rome III criteria of FD. Upper endoscopy was performed in all subjects, both with and without alarm features. Eighty consecutive children ages 7 to 15 were recruited. Nine (11.3%) had experienced alarm features. Five (6.3%) had organic diseases confirmed in upper endoscopy: duodenal ulcer (n = 2), duodenitis with erosion (n = 2), and gastritis with erosion (n = 1), 33.3% of children having alarm features had organic pathology, compared with 2.8% of those without (P < 0.01). A male predominance (80% vs 25.3%, P < 0.01), higher prevalence of alarm features (60% vs 8%, P < 0.01), and higher prevalence of Helicobacter pylori infection (80% vs 5.3%, P < 0.01) were found in children with organic diseases, compared with FD. Multivariate analysis identified H pylori infection (odds ratio 23.2; 95% confidence interval 1.5-333) and nocturnal pain (odds ratio 26.3; 95% confidence interval 1.2-500) to be independent predictors for positive endoscopic findings. Rome III recommendations of screening dyspeptic children for alarm features and investigation for H pylori are effective to identify children who have a higher likelihood of organic diseases and require upper endoscopy before making a diagnosis of FD.

Diagnostic Yield of Upper Endoscopy in Treated GERD Patients

Diagnostic Yield of Upper Endoscopy in Treated GERD Patients

Diagnostic Yield of Upper Endoscopy in Young Patients with Dysphagia

Diagnostic Yield of Upper Endoscopy in Young Patients with Dysphagia

ENDOSCOPIC FINDINGS IN A MYCOBACTERIUM AVIUM COMPLEX (MAC) INFECTION

Our patient is a 48 y/o AA female with a medical history including HIV/AIDs (CD4 count <50), Hepatitis C, COPD, and multi-substance abuse. She presented to our hospital with fevers, chest pain, and dyspnea Her PE revealed a cachectic but comfortable appearing patient with a non-focal exam. With a concern for TB, the patient was placed in respiratory isolation. Initial work-up revealed severe anemia, an elevated WBC and Alkphos, and sputum with subsequent 2+ AFB via fluorochrome stain. Due to the patient's clinical condition and persistent fevers a continued infectious work-up was performed. A CT revealed scattered areas of patchy lung disease, diffuse lymphadenopathy and small bowel wall thickening. An upper endoscopy was then obtained. The small bowel contained prominent and diffuse punctate white plaques. They were circumferential throughout the visualized small bowel. Plaques were approximately 1–2 mm in size (endoscopic photos available). The intervening mucosa appeared normal. Biopsies showed abundant acid fast intracellular bacilli. On hospital day #28 the sputum revealed MAC (via DNa Probe). The final diagnosis was disseminated MAC infection. Disseminated MAC is often a difficult diagnosis. Descriptions of endoscopic findings of disseminated MAC are rare in the literature. The diagnosis is usually made through isolation of MAC from the blood cultures. The mean time for positive blood cultures is 24 days (1). It is known that a low CD4 count is one of the primary risk factors for MAC infection. Disseminated infection usually presents with non-specific symptoms and laboratory abnormalities. Other studies such as stool studies and CT scans can be of assistance. One study showed that 14% of disseminated MAC had small bowel wall thickening on CT scan (2). Many patients with disseminated MAC will undergo an endoscopic work up prior to a definitive diagnosis. With the era of HAART, the evaluation of HIV patients is an evolving practice. Nevertheless, endoscopic evaluation is a key component in the work up of many signs and symptoms. Several studies have evaluated the yield of upper endoscopy for Opportunistic Infections (OI) in HIV patients (3). The diagnostic yield of upper endoscopy for OI is about 25% (4). This case provides us with the impressive visual appearance and histological findings in disseminated MAC with prominent intestinal involvement. References 1–4 available upon request.

Upper Endoscopy in Patients with GERD-Related ENT Symptoms

Endoscopy is not recommended for evaluating patients with extraesophageal complications of gastroesophageal reflux disease (GERD) because of the reportedly low prevalence of erosive esophagitis in these patients. However, this recommendation is based on studies limited by size and by the accuracy of assessment modalities. In this study, researchers prospectively evaluated the diagnostic yield of upper endoscopy in 405 consecutively referred patients with chronic and unexplained ear, nose, and throat (ENT) …

Diagnostic yield of upper endoscopy and colonoscopy in asymptomatic anemia

Diagnostic yield of upper endoscopy and colonoscopy in asymptomatic anemia

Diagnostic yield of upper endoscopy in Asian patients presenting with dyspepsia

Background: The aim of this study was to determine the frequency of diagnosis of significant disease by EGD in Asian patients of various ages with simple dyspepsia. Methods: Database records of 10,488 consecutive patients undergoing EGD between 1992 and 1998 were analyzed. The frequency of significant upper GI disease (defined as esophagitis, peptic ulcer, and cancer) in patients presenting with simple dyspepsia was determined for various age groups. Results: For the indication simple dyspepsia, 5066 (48.3%) EGDs were performed. At 988 (19.5%) EGDs, significant disease was noted (peptic ulcer 14.9%, esophagitis 5.0%, stomach cancer 0.47%, esophageal cancer 0.06%). There was a positive correlation between disease frequency and increasing age. The cumulative percentages of significant disease by age group were as follows: 10.8% in patients less than 35 years of age, 11.9% for those less than 40 years old, 13.7% for patients less than 45 years of age, and 19.5% overall. The cumulative frequencies of gastric cancer by age group were as follows: 0.68 of 1000 EGDs in patients less than 35 years of age, 1.15 of 1000 EGDs in patients less than 45 years old, and 9.60 of 1000 EGDs in patients greater than 45 years of age. Conclusion: The present study provides data to assist decision-making regarding the use of EGD in the patient population of Singapore. For patients with simple dyspepsia residing in Singapore, an age threshold of 45 years is reasonable inasmuch as gastric cancer is rarely found at endoscopy in younger patients. The age threshold for EGD for simple dyspepsia for Asians residing in other parts of the world would have to be determined based on the local prevalence of gastric cancer. (Gastrointest Endosc 2002;56:548-51.)