Yield Of Upper Gastrointestinal Endoscopy Research Articles

Severe Unexplained Iron Deficiency Anemia in Children: High Yield of Upper Gastrointestinal Endoscopy Regardless of Gastrointestinal Symptoms.

In this retrospective study spanning 2016 to 2022, we aimed to evaluate the diagnostic utility of upper gastrointestinal endoscopy (UGE) in children under 18 years presenting with severe unexplained iron deficiency anemia (IDA), defined as microcytic anemia of hemoglobin ≤7g/dL with low ferritin levels. Of 106 children hospitalized for severe anemia, 29 had unexplained IDA (mean hemoglobin level of 6.2 [3.2 to 6.9] gr/dL), and 25 of them underwent UGE. The mean age was 10.7 ± 3.9 years, with 76% being female. Ten children (40%) had gastrointestinal (GI) symptoms at presentation. The cause of IDA was found in 18 (72%) of 25 children who underwent UGE, of whom 12 were without GI symptoms. Gastric nodularity, erosions, or polyps were observed in 68%, and gastritis was evident in 72% based on histopathology. Helicobacter pylori was found in 50% of those with gastritis. Follow-up showed normalized hemoglobin levels in 92% of cases, with only 2 children requiring repeat iron therapy. Our findings underscore the importance of incorporating UGE into the diagnostic investigation of severe unexplained IDA in children, irrespective of the presence of GI symptoms.

The Diagnostic Yield of Upper GI Endoscopy in Patients Iron Deficiency Anemia and/or Chronic Diarrhea

Aim of the study: According to published guidelines, an upper gastrointestinal (GI) endoscopy with duodenal biopsy sampling should be performed in patients with iron deficiency anemia (IDA) and/or chronic diarrhea. The cost-effectiveness of this strategy in the absence of obvious endoscopic reason explaining patients’ symptoms has not been thoroughly investigated. Aim of our study was to access the clinical benefit of such a strategy. Patients-Methods: All patients who underwent an upper GI endoscopy in our department due to IDA and/ or chronic diarrhea during a 5-year period (1/2015-12/2019) were included in our study. Epidemiological, endoscopic and histologic data were analyzed. Results: The indication for endoscopy was IDA in 350 and chronic diarrhea in 108 patients; histological reports were available in 311 and 100 patients, respectively. Visual abnormalities were observed in 157 patients (34.3% in total; IDA: 32.9%, chronic diarrhea: 38.9%) and were more frequent among males than females (44.6% vs 33.5%, p=0.019) and among older patients (mean age 60 vs 56 years old, p=0.006). The histology report provided a conclusive diagnosis in 71/413 patients (17.2% in total; IDA: 14.8 %, chronic diarrhea: 25%). Celiac disease (CD) was diagnosed in 7.5% of our total study group. Normal endoscopic appearance of the duodenum was observed in 33% of patients, while bulb atrophy was associated more frequently with a conclusive histological report compared to other or no endoscopic findings (23/63 or 36.5% vs 48/350 or 13,7%, p<0,001). Conclusions: Duodenal biopsy can aid significantly in the diagnosis of IDA or chronic diarrhea, even among patients without endoscopically abnormalities. Duodenal atrophy is an endoscopic marker that may lead to a conclusive histological diagnosis, most commonly CD, in 1 out of 3 patients

The Diagnostic Yield of Upper GI Endoscopy in Patients Iron Deficiency Anemia and/or Chronic Diarrhea; With a Special Focus on Celiac Disease

Aim of the Study: According to published guidelines, an upper Gastrointestinal (GI) endoscopy with duodenal biopsy sampling should be performed in patients with Iron Deficiency Anemia (IDA) and/or chronic diarrhea. The cost-effectiveness of this strategy in the absence of obvious endoscopic reason explaining patients symptoms has not been thoroughly investigated. Aim of our study was to access the clinical benefit of such a strategy. Patients-Methods: All patients who underwent an upper GI endoscopy in our department due to IDA and/or chronic diarrhea during a 5-year period (1/2015-12/2019) were included in our study. Epidemiological, endoscopic and histologic data were analyzed. Results: The indication for endoscopy was IDA in 350 and chronic diarrhea in 108 patients; histological reports were available in 311 and 100 patients, respectively. Visual abnormalities were observed in 157 patients (34.3% in total; IDA: 32.9%, chronic diarrhea: 38.9%) and were more frequent among males than females (44.6% vs 33.5%, p=0.019) and among older patients (mean age 60 vs 56 years old, p=0.006). The histology report provided a conclusive diagnosis in 71/413 patients (17.2% in total; IDA: 14.8 %, chronic diarrhea: 25%). Celiac Disease (CD) was diagnosed in 7.5% of our total study group. Normal endoscopic appearance of the duodenum was observed in 33% of patients, while bulb atrophy was associated more frequently with a conclusive histological report compared to other or no endoscopic findings (23/63 or 36.5% vs 48/350 or 13,7%, p<0,001). Conclusions: Duodenal biopsy can aid significantly in the diagnosis of IDA or chronic diarrhea, even among patients without endoscopical abnormalities. Duodenal atroph

Diagnostic Yield of Endoscopy in Upper Gastrointestinal Bleeding in Pediatrics

Introduction Esophagogastroduodenoscopy is currently considered the first-line diagnostic procedure of choice for upper gastrointestinal (GI) bleeding; however, the etiology of bleeding remains unknown in a subset of patients. This study aims to evaluate the diagnostic yield of upper gastrointestinal endoscopy in upper gastrointestinal bleeding in pediatrics and determine the clinical predictors for unreached diagnosis during endoscopy. Methods Cross sectional study, conducted at pediatric endoscopy unit, Ain Shams University, Cairo, Egypt, where 100 patients were recruited, as they were referred for diagnostic upper GI endoscopy due to overt upper GI bleeding in the form of hematemesis and/or melena. Full medical history, examination, laboratory investigations, endoscopic and histopathologic findings were documented. Results :100 patients with ages ranging from 3 months to 15 years, median age 4 years, 47% males and 53% females, 65% presented by hematemesis only, 7% with melena only, and 28 % presented with both hematemesis and melena. In 38 % of cases no endoscopic diagnosis was reached. While patients with a positive diagnostic yield 62%, had variable diagnosis, the most common of which was H pylori gastritis and reflux oesophagitis in 23% and 11% of cases respectively. Followed by nonspecific gastritis (8%), oesophageal varices (4%), and others (16%).. Melena was a negative predictor to reach a diagnosis by upper GI endoscopy. Conclusion Diagnostic yield of upper GI endoscopy in pediatric patients with upper GI bleeding was only 62%. Combining upper GI endoscopy with other tools in cases presenting with melena alone is highly recommended since bleeding from a source in the small bowel or right colon may also be the cause.

Diagnostic yield of upper gastrointestinal endoscopy in patients attending a UK centre with symptoms compatible with Rome IV functional dyspepsia

BackgroundDyspeptic symptoms are common and mainly due to functional dyspepsia (FD). The Rome IV criteria mandate a normal upper gastrointestinal (UGI) endoscopy before diagnosing FD. However, endoscopies are costly, resource-intensive...

The yield of upper gastrointestinal endoscopy in patients below 60 years and without alarm symptoms presenting with dyspepsia

Background and aims Upper gastrointestinal (GI) endoscopy is frequently performed in patients with upper abdominal symptoms. Although guidelines recommend withholding an endoscopy in the absence of alarm symptoms, dyspeptic symptoms remain a predominant indication for endoscopy. We aimed to investigate the yield of upper GI endoscopy in patients with low-risk dyspeptic symptoms. Methods We conducted an analysis in a prospectively maintained endoscopy reporting database. We collected the results of all upper GI endoscopy procedures between 2015 and 2019 that was performed in adult patients aged <60 years with dyspeptic symptoms. Patients with documented alarm symptoms were excluded. We categorized endoscopic findings into major and minor endoscopic findings. Results We identified 26,440 patients with dyspeptic symptoms who underwent upper GI endoscopy. A total of 13,978 patients were considered low-risk and included for analysis (median age 46 years, interquartile range (IQR) [36–53], 62% female). In 11,353 patients (81.2%), no endoscopic abnormalities were detected. Major endoscopic findings were seen in 513 patients (3.7%) and minor endoscopic findings in 2178 patients (15.6%). Endoscopic findings indicative of upper GI cancer were reported in 47 patients (0.3%), including 16 (0.1%) oesophageal, 28 (0.2%) gastric and 5 (0.04%) duodenal lesions. Despite an initial unremarkable endoscopy result, 1015 of 11,353 patients (8.9%) underwent a follow-up endoscopy after a median of 428 days [IQR 158–819]. This did not lead to the additional identification of malignancy. Conclusions The yield of upper GI endoscopy in low-risk (<60 years, no alarm symptoms) patients with dyspepsia is very limited. This study further supports a restrictive use of upper GI endoscopy in these patients.

Diagnostic yield of esophagogastroduodenoscopy in France

Background and study aimsLarge scale data on esophagogastroduodenoscopy (EGD) in Western countries are scarce. We conducted a prospective study on the diagnostic yield of upper gastrointestinal endoscopy in France. Patients and methodsAn online questionnaire was sent to all French gastroenterologists practicing endoscopy. Data from EGDs performed during one week were collected. A statistical extrapolation of the results to a whole year was performed. Results342 gastrointestinal endoscopists, representative of the population of French gastroenterologists, provided data on 2735 EGDs, corresponding to 1 006 316 (95%CI=937 080−1 075 552) procedures for the entire year. 1770 (64.7%) EGDs were performed under sedation or general anesthesia, and 930 (34%) were associated with a colonoscopy. 896 (32.8%) EGDs were normal. Hiatal hernia and esophagitis were the most frequent esophageal diagnoses, in 496 (18.1%) and 374 (13.7%) cases, respectively. Barrett’s esophagus was diagnosed in 109 (4%) patients. Among gastric lesions, endoscopic gastritis was reported in 572 (20.9%) patients; ulcer, polyps, and suspected malignancy in 78 (2.9%), 62 (2.3%), and 19 (0.7%), respectively. 1597 (58.4%) EGDs included mucosal biopsies, and 141 (5.1%) were associated with a therapeutic procedure. ConclusionsWe report nationwide prospective data on upper gastrointestinal endoscopy practice in France. Our data suggest that about 300 000 normal EGDs each year in France could potentially be avoided by a diagnostic strategy relying on upper GI capsule endoscopy, providing significant relief on healthcare practitioners.

Diagnostic Yield of Upper Gastrointestinal Endoscopy in Children: A Three Years Experience

Introduction: Gastrointestinal disorders are very common in paediatric population. Upper Gastrointestinal Endoscopy procedures have increased dramatically worldwide and have contributed in identification of various gastrointestinal disorders along with therapeutic benefits. However, it is recently being established in paediatric population in Nepal and proper data is scarce. This study was aimed to assess upper gastrointestinal endoscopy with respect to its indications and diagnostic yield at a tertiary centre over a three years period.&#x0D; Methods: This is a retrospective observational study where data of all paediatric patients between the age group 0 - 15 years having various gastrointestinal problems who underwent upper gastrointestinal endoscopy from March 2013 - Feb 2016 in our centre were analysed.&#x0D; Results: Among 270 patients, males comprised 60% and females comprised 40%. Age range was 0 - 15 years and majority were from the age group between 10 to 15 years (66.2%). Most common indications for endoscopy were chronic abdominal pain (58.8%), acute epigastric pain (18.5%), followed by failure to thrive (7%). Abnormal findings were detected in 250 patients (92.5%); gastroduodenitis (28.14%), antral gastritis (18.51%), erosive gastritis (15.92%), duodenitis (9.25%), hiatus hernia (7.4%), varices (5.5%) were common findings. Histopathologically, chronic gastritis and duodenitis (72%) were common findings followed by acute gastritis and giardiasis. Among 80 patients who underwent RUT, 50% each had positive and negative results.&#x0D; Conclusion: Chronic abdominal pain remains common gastrointestinal problem in children. With the advent of upper gastrointestinal endoscopy various gastrointestinal problems can be identified and managed accordingly. Along with the facility of histopathology, diagnostic yield and outcome is further enhanced.

Changes in Time in Yield of Upper Gastrointestinal Endoscopy in Relation to the Applicants Speciality

Introduction: The diagnostic yield of upper gastrointestinal endoscopy (UGE) is high. Aim: A study was done in order to relate the outcome of UGE to the speciality of the applicant and to study changes in yield in a long period of time. Material and Methods: A large dataset was used. The endoscopic diagnoses were noted as a percentage of the yearly procedures done on request of the specific applicant. The following endoscopic diagnoses were primarily scored: reflux oesophagitis, peptic ulcer disease, hiatal hernia or insufficient gastric cardia, and cancer. Results: A total of 36650 procedures were studied via the general practitioner (GP) in 14913 cases (40.6%), the gastroenterologist in 6993 (19%), surgeon or cardiologist in 496 (1.4%) and in 14248 cases (38.9%) via the internist. No abnormalities and reflux oesophagitis were significantly more often scored in cases done on request of the GP. Cancer was more often seen in cases with the gastroenterologist as the applicant. After an initial rise incidence of hiatal hernia, insufficient cardia, and reflux oesophagitis, both findings show a decrease since 2007. There is some yearly fluctuation in presence of reflux-oesophagitis and cancer, while peptic ulcer disease decreases. Conclusion: The general yield of UGE is relatively high. There are differences in outcome if the applicant is taken into account. It is also clear that gastro-oesophageal reflux disease is a condition mostly treated by general practitioners.

Value of upper gastrointestinal endoscopy in evaluating patients presenting with dyspepsia

Introduction Dyspepsia is a common symptom that is encountered in clinical practice and upper gastrointestinal endoscopy (UGIE) has gained wide acceptance in the evaluation of dyspepsia. This study was aimed to determine the yield of UGIE in patients presenting with dyspepsia to a tertiary care centre. Methods A retrospective analysis of patients followed up at a single unit in a tertiary care hospital from 2007 to 2016 was carried out. Patients who underwent UGIE for evaluation of dyspepsia were included in the study. Those with additional symptoms like dysphagia, loss of weight, loss of appetite and pancreato-biliary pathology were not included. The yield of UGIE in patients with dyspepsia (i.e.peptic ulcer, gastritis, polyp, cancer) in relation to two age groups (≤40years and >40 years) was determined and compared. Results A total of 491 patients were analysed (males=259, 52.7% ; mean age=46.65±SD21.93 years). Among them, 31.97 %(n=157) were aged 40 years or less. Abnormalities were detected in 01(61.3%) patients (peptic ulcer-2.44%, gastritis-20.4%, polyp-3.9%, endoscopically malignant lesions-3.2%). In the ≤40 age group, 58.6%(n=93) had positive endoscopic findings (i.e.peptic ulcer-1.2%, gastritis- 25.5%, polyp-1.2%, endoscopically malignant lesions-1.9%) while in the >40 year group, 62.6% had positive endoscopic findings (i.e.peptic ulcer-3.0%, gastritis-18.8%, polyp-5.1%, endoscopically malignant lesions-4.0%). Only two endoscopically malignant lesions were histologically malignant and both were detected in those who were aged more than 40 years. Conclusions In this study, the diagnostic yield of UGIE in detecting peptic ulcers, inflammatory and neoplastic lesions were considerably high in both age groups. Therefore, the age threshold for endoscopy may be lowered to avoid missing a significant lesion.

Appropriateness and diagnostic yield of upper gastrointestinal endoscopy in an open-access endoscopy system

Background/Aim:Open access endoscopy (OAE) decreases the waiting time for patients and clinical burden to gastroenterologist; however, the appropriateness of referrals for endoscopy and thus the diagnostic yield of these endoscopies has become an important issue. The aim of this study was to determine the appropriateness of upper gastrointestinal (GI) endoscopy requests in an OAE system.Patients and Methods:A retrospective chart review of all consecutive patients who underwent an upper gastroscopy in the year 2008 was performed and was defined as appropriate or inappropriate according to the American Society for Gastrointestinal Endoscopy (ASGE) guidelines. Endoscopic findings were recorded and classified as positive or negative. Referrals were categorized as being from a gastroenterologist, internist, surgeon, primary care physicians or others, and on an inpatient or out-patient basis.Results:A total of 505 consecutive patients were included. The mean age was 45.3 (standard deviation 18.1), 259 (51%) of them were males. 31% of the referrals were thought to be inappropriate. Referrals from primary care physicians were inappropriate in 47% of patients while only 19.5% of gastroenterologists referrals were considered inappropriate. Nearly, 37.8% of the out-patient referrals were inappropriate compared to only 7.8% for inpatients. Abnormal findings were found in 78.5% and 78% of patients referred by gastroenterologists and surgeons respectively while in those referred by primary care physicians it was (49.7%). Inpatients referred for endoscopy had abnormal findings in (81.7%) while in out-patients it was (66.6%). The most common appropriate indications in order of frequency were “upper abdominal distress that persisted despite an appropriate trial of therapy” (78.9%), “persistent vomiting of unknown cause” (19.2%), upper GI bleeding or unexplained iron deficiency anemia (7.6%). The sensitivity and specificity of the ASGE guidelines in our study population was 70.3% and 35% respectively.Conclusion:A large proportion of patients referred for endoscopy through our open-access endoscopy unit are considered inappropriate, with significant differences among specialties. These results suggest that if proper education of practitioners was implemented, a better utilization would be expected.

Appropriate use and diagnostic yield of upper gastrointestinal endoscopy in a tertiary referral hospital

Background and study aimsThis is a prospective, descriptive, hospital-based study to evaluate the appropriateness and diagnostic yield of upper gastrointestinal (GI) tract endoscopy referrals to Soba University Hospital endoscopy unit using the American Society for Gastrointestinal Endoscopy guidelines for appropriate use of endoscopy. Patients and methodsAll patients referred to Soba University Hospital for upper GI endoscopy during the study period were enrolled in the study after giving an informed consent. Statistical analysis was done using the Statistical Package for Social Sciences (SPSS) program to calculate frequencies and the X2 test; P value was taken as significant at a level of less than 0.05. ResultsOverall, 220 patients were prospectively enrolled in the study, of which 126 (57%) were males, with a mean age of 46.5±17.9years. A total of 190 patients (86%) were appropriately referred and the overall diagnostic yield was 46.8%. Those with appropriate referral had a higher diagnostic yield (50%) when compared to those with inappropriate referral (23%). ConclusionThe diagnostic yield of upper GI endoscopy was higher when patients were referred appropriately indicating that detection of relevant finding is greatly enhanced by the utilisation of standard guidelines.

Diagnostic Yield of Upper Gastrointestinal Endoscopy in the Evaluation of Iron Deficiency Anemia in Older Children and Adolescents

Iron deficiency anemia (IDA) is frequent in childhood. Inadequate nutrition and gastrointestinal malabsorption are the frequent causes of IDA in children. But reduced iron absorption and insidious blood loss from the gastrointestinal tract has been identified as the most frequent causes of IDA in older children and adolescents. Therefore the authors evaluated the frequency and etiologies of the upper gastrointestinal system pathologies causing IDA in older pediatric population. Patients with known hematological or chronic diseases, heavy menstrual flow, and obvious blood loss were excluded from the study. Forty-four children between the ages of 9.5 and 17.5 years and diagnosed with IDA were enrolled. They underwent upper gastrointestinal endoscopy and biopsy from esophagus, stomach, and duodenum. Mean age and hemoglobin (Hb) levels of study group (32 boys, and 12 girls) were 14.6 ± 2.0 years and 7.9 ± 1.8 g/dL, respectively. Only 1 patient had a positive serology testing with anti-tissue transglutaminase and small bowel biopsy correlating with celiac disease. Endoscopy revealed abnormal findings in 25 (56.8%) patients (21 endoscopic antral gastritis, 2 active duodenal ulcers, and 2 duodenal polyps). Helicobacter pylori (HP) infection was identified by using antral histopathological evaluation in 19 of 44 children (43.2%). In 2 of duodenal samples, one patient had celiac disease, and the other one was diagnosed as giardiasis. In conclusion, there are different etiologies resulting in IDA in older children and adolescents. When older children and adolescents are found to have iron deficiency, HP infection and other gastrointestinal pathologies should be ruled out before iron deficiency treatment.

Appropriateness of outpatient gastrointestinal endoscopy in a non-academic hospital

To assess the appropriate use and the diagnostic yield of upper gastrointestinal endoscopy and colonoscopy in this subgroup of patients. In total, 789 consecutive outpatients referred for gastrointestinal (GI) endoscopy [381 for esophagogastroduodenoscopy (EGD) and 408 for colonoscopy] were prospectively enrolled in the study. The American Society for Gastrointestinal Endoscopy (ASGE) guidelines were used to assess the relationship between appropriateness and the presence of relevant endoscopic findings. The overall inappropriate rate was 13.3%. The indications for EGD and colonoscopy were, respectively, appropriate in 82.7% and 82.6% of the exams, uncertain in 5.8% and 2.4% and inappropriate in 11.5% and 15%. The diagnostic yield was significant higher for EGDs and colonoscopies judged appropriate and uncertain when compared with those considered inappropriate (EGD: 36.6% vs 36.4% vs 11.4%, P = 0.004; Colonoscopy: 24.3% vs 20.0% vs 3.3%, P = 0.001). Of the 25 malignant lesions detected, all but one was detected in exams judged appropriate or uncertain. This study shows a good adherence to ASGE guidelines by the referring physicians and a significant increase of the diagnostic yield in appropriate examinations, namely in detecting neoplastic lesions. It underscores the importance that the appropriateness of the indication assumes in assuring high-quality GI endoscopic procedures.

The yield of upper gastrointestinal endoscopy in patients with suspected reflux-related chronic ear, nose, and throat symptoms.

It is well established that various ENT disorders and symptoms may be a manifestation of gastroesophageal reflux disease (GERD). Erosive esophagitis is considered a rare finding in ENT patients and therefore upper gastrointestinal (GI) endoscopy is not recommended in the diagnostic work-up. However, large prospective studies underscoring this policy are lacking. The aim of the present study was to investigate the prevalence and severity of esophagitis in patients with suspected GERD-related chronic ENT symptoms. Endoscopy was performed in 405 ENT patients with suspected GERD and 545 typical GERD patients. The presence of erosive esophagitis, Barrett's esophagus, hiatal hernia, peptic ulcer, and Helicobacter pylori infection on biopsies was determined and compared with the results of a symptom questionnaire. The prevalence of erosive esophagitis (52.3% vs 38.4%; p < 0.05), mainly grade 1 (31.9% vs 22.7%; p < 0.05), and of peptic ulcer (8.4% vs 4.3%; p < 0.05) was significantly higher in patients with GERD-related ENT symptoms compared to typical GERD. Barrett's mucosa occurred in, respectively, 4.9% and 4.5% of the patients (NS). Esophagitis prevalence was highest in patients with predominant cough and lowest in globus pharyngeus and throat symptoms. The presence of esophagitis was associated with significantly higher rates of symptom relief during the first 8 wk of proton pump inhibitor (PPI) therapy. Patients with suspected GERD-related ENT symptoms have a high prevalence of esophagitis and this is associated with better response to antisecretory therapy.

Yield of endoscopy in dyspepsia and concurrent treatment with proton pump inhibitors: The blind leading the blind?

Yield of endoscopy in dyspepsia and concurrent treatment with proton pump inhibitors: The blind leading the blind?

Upper gastrointestinal endoscopy in patients aged 85 years or more. Results of a feasibility study in a district general hospital

We performed a cross sectional analysis of the feasibility and yield of upper gastrointestinal endoscopy (UGE) in a cohort of patients aged 85 years or more. The study involved 218 patients who underwent diagnostic upper gastrointestinal endoscopy in a district general hospital between 1994 and 1998. Indication, use of sedation, endoscopic findings and treatment after endoscopy were evaluated. Indications for gastroscopy were suspicious of upper gastrointestinal bleeding (UGI) bleeding (41%), anemia (15%), and presence of dyspeptic- (31%), alarm- (9%) and/or reflux symptoms (3%). Serious UGI disease (cancer, peptic ulcer, reflux oesofagitis and/or erosive gastritis/duodenitis) was detected in 97 patients (44%). With respect to clinical presentation, serious UGI disease was present in 61% with bleeding, in 57% with reflux symptoms, in 42% with alarm symptoms, in 33% with anemia and in 28% with dyspepsia. Carcinoma was detected in eight patients (3.8%), all of them were treated with supportive care. In very old people gastroscopy is generally performed on sound indications reveals serious UGI disease in almost one out of two patients, markedly influences medical treatment, and reveals low malignancy rates (3.8%). In these patients, UGE is worthwhile and should not be omitted because of age considerations.

Appropriateness and diagnostic yield of upper gastrointestinal endoscopy in an open-access endoscopy system: a prospective observational study based on the Maastricht guidelines.

To test the appropriateness of referrals for upper gastrointestinal endoscopy in Campania, Italy, using the criteria of the Maastricht Consensus. Patients undergoing endoscopy during a 1-week period in 21 Endoscopy Services were considered prospectively. The reasons for endoscopy were dyspeptic symptoms, history of peptic ulcer and assessment after treatment. The age, sex, symptoms, history of peptic ulcer (previous endoscopic or radiographic examinations and treatment), endoscopic diagnosis and H. pylori status were recorded. The indications for endoscopy were evaluated according to the Maastricht guidelines. Two hundred and sixteen of 706 patients presented with reflux symptoms, 430 with dyspeptic symptoms, 38 with alarm symptoms and 22 with atypical symptoms. Endoscopy was normal in 376 cases (53.2%); duodenal ulcer was found in 219, gastric ulcer in 45, oesophagitis in 82 and gastric cancer in six. All patients with cancer were older than 45 years, and four presented with alarm symptoms. In 398 cases (56%), endoscopy was considered not to be indicated: 250 patients with a previous diagnosis of ulcer without a change in symptoms, 38 patients in order to confirm eradication and 110 patients younger than 45 years with dyspepsia without alarm symptoms. A large number of endoscopic examinations could be avoided by following the guidelines of the Maastricht Consensus. In order to reduce endoscopic workload, strategies for educating physicians should be pursued.

Appropriateness and diagnostic yield of upper gastrointestinal endoscopy in an endoscopy system: A prospective observational study based on the maastricht guidelines

Appropriateness and diagnostic yield of upper gastrointestinal endoscopy in an endoscopy system: A prospective observational study based on the maastricht guidelines

Diffusion of Knowledge about Helicobacter pylori as Assessed in an Open-Access Endoscopy System: A Prospective Observational Study Based on the Maastricht Guidelines

Background/Aim: Aim of the present study is to assess, according to the guidelines of the Maastricht Consensus Conference, the appropriateness and diagnostic yield of upper gastrointestinal endoscopy in an open-access endoscopy system, in order to evaluate the diffusion of knowledge about Helicobacter pylori among different types of physicians. Methods: Patients undergoing endoscopy because of dyspeptic symptoms were prospectively considered in 21 endoscopy services of Campania during two different 1-week periods in 1998 and 2001. The following data were recorded: age, sex, symptoms, history of peptic ulcer with regard to previous endoscopic or radiographic examinations and treatment, endoscopic diagnosis, and H. pylori status. The indication for endoscopy was evaluated according to Maastricht guidelines and current medical knowledge. Results: In the two periods, 1998 and 2001, 706 and 520 patients were, respectively, considered. The two series were matched for demographic characteristics, symptoms, and endoscopic diagnosis. Endoscopy was considered not indicated in 398 patients (56.4%) in 1998 and in 265 patients (50.9%) in 2001 (p = NS). The majority of them, 288/398 (72.3%) in 1998 and 162/265 (61.1%) in 2001 (p = 0.001), had recently undergone endoscopy or radiology and empiric antisecretory treatment or eradication. They had been referred to endoscopy because of recurrence of symptoms or to assess healing. In 110 cases in 1998 (27.6%) and in 103 cases in 2001 (38.9%; p = 0.001) endoscopy was performed in dyspeptic patients younger than 45 years without alarm symptoms. Conclusions: 4 years after the Maastricht Conference, a large number of endoscopic examinations are not indicated and could be avoided following the Maastricht guidelines. In 2001, in comparison to 1998, a larger number of physicians are likely to investigate and treat correctly the H.-pylori-related diseases, but there are still some problems with the application of the ‘test-and-treat policy’.