[First-line exploration: fiberoptic gastroscopy or barium meal? A pragmatic evaluation (author's transl)]

The influence of the initial upper GI tract exploration upon the accuracy and cost of diagnosis was evaluated in 103 in- and out-patients of a hepato-gastroenterology unit. The patients were divided at random into two groups of comparable number, age, sex and clinical findings. One group was first examined by fiberoptic gastroscopy and the other by barium meal. In patients whose first examination was by endoscopy a second examination was less frequently needed (3/53 versus 14/50; p less than 0.01), significant lesions (e.g. oesophagitis, oesophageal varices, gastroduodenal losses of substance or tumours) were more often diagnosed (22/53 versus 11/50; p less than 0.05) and the time required for a diagnosis to be made was shorter (mean 7 +/- 6 days versus 14 +/- 16 days; p less than 0.01), even when only one examination was performed (7 +/- 6 days versus 12 +/- 15 days; p less than 0.05), than in patients first examined by barium meal. It is concluded that fiberoptic gastroscopy should be the initial method of exploration of the upper GI tract.