Do Low-Risk Patients With Dyspepsia Need a Gastroscopy? Use of Gastroscopy for Otherwise Healthy Patients With Dyspepsia

Abstract

Background Choosing Wisely Canada (CWC) recommends not to perform gastroscopy for dyspepsia in otherwise healthy adults less than 55 years of age (2014). The aim of this study was to evaluate the use of gastroscopy in a young, healthy population with uncomplicated dyspepsia. Methods A retrospective review of gastroscopies completed during 3-month periods in 2015, 2016, and 2017 identified all patients undergoing gastroscopy for the primary indication of dyspepsia. Low-risk patients for dyspepsia were defined as adults, aged 18 to 54 years without alarm symptoms, comorbidities and/or abnormal imaging findings or laboratory values. Gastroscopy and pathology reports were reviewed to identify clinically actionable findings. Clinical outcomes were followed to December 31, 2018 including gastroenterology referrals, emergency room visitation and hospitalization. Results Among 1358 patients having a gastroscopy for dyspepsia, 480 (35%) were low-risk patients. Sixteen patients 3.3% (16/480) had a clinically actionable result found on gastroscopy or biopsy. No malignant lesions were detected. Low-risk patients were followed up for an average of 2.75 years, 8% (39/480) visited the emergency department (ED), 1% (3/480) of patients were admitted to hospital and 12% (59/480) of patients were re-referred for a dyspepsia-related concern. Interpretation A high rate of low yield, high cost, invasive endoscopic investigations were performed in this population of otherwise healthy patients under age 55 years. These data suggest limited uptake of current recommendations against the routine use of gastroscopy to investigate dyspepsia.

Diagnostic yield of upper gastrointestinal endoscopy in patients attending a UK centre with symptoms compatible with Rome IV functional dyspepsia

“…Limitations are that it was single centre, with a questionnaire response rate of 33%, although the findings of low diagnostic yield in those without alarm features is supported by other recent studies from the West. [13][14][15][16] Our study was performed in secondary care, with a mixed referral pattern, and the findings may not be applicable outside these clinical settings (e.g. in the community) where arguably the yield will be even lower.…”

“…The results are consistent with recent studies from the West (Canada, United States, Netherlands, and Sweden) which, having used a broader definition of dyspepsia, noted that almost a third to a half of upper GI endoscopies performed within GI clinics are in low risk dyspeptic patients without alarm features, in whom significant endoscopic findings were low, with malignancy rare. [13][14][15][16] To our knowledge, our study is the first evaluating this issue within the UK whilst using the Rome IV criteria.…”

Mistakes in the diagnosis and treatment of Helicobacter pylori infection in daily clinical practice

“…None of the study investigators had a financial incentive to perform endoscopies. Similarly, a study conducted in Canada reported that 65% of gastroscopies performed in patients with dyspepsia were based on the presence of alarm signs; 20 however, other study carried out in United Kingdom found that only 14.8% of gastroscopies in dyspeptic patients associated red flags 21 …”

Dyspepsia: terminology, causes and risk factors, patient management

“…В ретроспективном исследовании 2021 г. из 1 358 пациентов с неисследованной диспепсией 35% были отнесены в группу низкого риска выявления эндоскопических находок -их возраст составил от 18 до 54 лет, отсутствовали симптомы тревоги и сочетанные заболевания, патологические изменения лабораторных показателей. В этой группе при ЭГДС не было выявлено ни одного случая онкологического заболевания, а значимые эндоскопические находки выявлены в 3,3% случаев [14].…”