Repeated upper endoscopy in the Medicare population: a retrospective analysis

Area of Science:

• Gastroenterology
• Health Services Research
• Medical Economics

Background:

• Esophagogastroduodenoscopy (EGD) is a common diagnostic procedure with frequent indications.
• Limited data exists regarding the recurrence rates of EGD and the specific diagnostic drivers for repeat procedures.

Purpose of the Study:

• To determine the frequency of repeat esophagogastroduodenoscopy (EGD) within the Medicare population.
• To identify the primary diagnoses associated with repeated EGD procedures.

Main Methods:

• Retrospective analysis of a 5% random sample of Medicare beneficiaries from 2004 to 2006.
• Utilized Current Procedural Terminology (CPT) codes for index EGD identification.
• Classified index diagnoses into expected, uncertain, or not expected groups for repeat EGD.

Main Results:

• Approximately 12% of Medicare beneficiaries had an EGD, with 33% undergoing at least one repeat EGD within three years.
• Only 10% of initial EGDs had diagnoses suggesting a follow-up was needed, while 61% did not.
• Excluding new clinical events, 43% of repeat EGDs lacked a justifying diagnosis at either the index or repeat examination.

Conclusions:

• One-third of Medicare beneficiaries receiving an EGD had a repeat procedure within three years.
• Nearly half of repeat EGDs were performed in patients whose diagnoses did not indicate a need for re-examination.
• The clinical indication for individual repeat EGD procedures could not be definitively verified.