Appropriateness of indications for diagnostic upper gastrointestinal endoscopy: Association with relevant endoscopic disease

• Published in: Gastrointestinal endoscopy Vol. 42; no. 5; pp. 390 - 397
• Main Authors: Adang, Rob P., Vismans, Jon F-J.F.E., Talmon, Jan L., Hasman, Arie, Ambergen, Anton W., Stockbrügger, Reinhold W.
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01-11-1995; Elsevier
• Subjects: Biological and medical sciences; Digestive system. Abdomen; Endoscopy; Endoscopy, Gastrointestinal - standards; Endoscopy, Gastrointestinal - statistics & numerical data; Female; Gastrointestinal Diseases - diagnosis; Gastrointestinal Diseases - epidemiology; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Patient Selection; Prospective Studies; Referral and Consultation - standards; Referral and Consultation - statistics & numerical data; Human; Stomach; Dyspepsia; Indication; Gut; Digestive diseases; Diagnosis; Endoscopy; Gastrointestinal
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/S0016-5107(95)70037-4

Background: Since the institution of open access endoscopy units there has been a considerable increase of referrals for UGI examinations. Therefore, guidelines for the appropriate use of UGI endoscopy are needed.
Methods: The outcome of first diagnostic UGI endoscopy was prospectively assessed for several referral indications in a consecutive series of 2900 patients. Indications were judged “appropriate” when significantly (
p < 0.01) associated with clinically “relevant” endoscopic findings.
Results: The proportion of relevant disease for various indications was as follows: signs of UGI bleeding (42.2%); history of peptic ulcer (40.5%); dysphagia (34.4%); anorexia and weight loss (34.3%); isolated dyspepsia with long-term (31.9%), short-term (24.4%), and without therapy (20.9%). Relevant endoscopic findings were observed in 21.0% of dyspeptic patients aged 45 years or less, and in 25.3% of those older than 45 years of age.
Conclusions: The generally approved alarm symptoms should be a reason to perform endoscopy without hesitation. Dyspeptic symptoms, despite adequate empiric treatment, as well as first dyspeptic symptoms in patients older than 45 years should also be a reason for endoscopic investigation. Our results support the strategy to treat patients younger than 45 years who have isolated dyspepsia by a limited course of antipeptic agents, provided that they are seen for re-evaluation within 4 to 6 weeks. (Gastrointest Endosc 1995;42:390-7.)