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Appropriateness of indications for diagnostic upper gastrointestinal endoscopy: association with relevant endoscopic
R P Adang1, J F Vismans, J L Talmon
1Department of Gastroenterology and Hepatology, University Hospital, Maastricht, The Netherlands.
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 (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.