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Gastric ulcers at endoscopy: brush, biopsy, or both?
1Department of Medicine, University of Alberta, Edmonton, Canada.
The American Journal of Gastroenterology
|April 1, 1997
Summary
For gastric ulcers, using either cytological brushing or histological biopsy alone is cost-effective for detecting malignancy. Performing both methods increases false positives and costs, making the combined approach less favorable.
Area of Science:
- Gastroenterology
- Oncology
- Health Economics
Background:
- Gastric ulcers found during endoscopy may indicate malignancy.
- Combining histological biopsy and cytological brushing aims to improve neoplasia detection rates.
Purpose of the Study:
- To evaluate the cost-effectiveness of different diagnostic strategies for detecting malignancy in gastric ulcers.
- To compare biopsy alone, brushing alone, and combined biopsy and brushing approaches.
Main Methods:
- A meta-analysis of published reports estimated diagnostic performance for biopsy and brushings.
- Direct costs were calculated from a Canadian hospital's patient resource data.
- A decision tree model compared diagnostic strategies in a hypothetical cohort of gastric ulcer patients.
Main Results:
- No single strategy dominated others in cost-effectiveness.
- Cytological brushing was the most cost-effective, with a ratio only slightly better than biopsy.
- The combined approach doubled the false-positive rate, leading to unnecessary surgeries and increased costs ($168-$423 per case).
Conclusions:
- For gastric ulcers, performing either cytological brushing or histological biopsy is the preferred diagnostic strategy.
- The routine use of both histological biopsy and cytological brushing should be reconsidered due to increased false positives and costs.