Open-Access Endoscopy: Are Age-Based Guidelines Justified? An Audit of Experience of 1000 Open-Access Endoscopies at a District General Hospital

Boulton-Jones, J. R.; Follows, Mark; Mahmoud, A. A.

doi:10.1055/s-2003-36407

Cited by 10 publications

(11 citation statements)

References 20 publications

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“…16 Diagnostic performance for failure of antacid medication from three studies [22][23][24] showed a low association with oesophagogastric cancer (Table 2).…”

Section: Other Symptomsmentioning

confidence: 99%

Diagnostic value of symptoms of oesophagogastric cancers in primary care: a systematic review and meta-analysis

et al. 2015

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“…16 Diagnostic performance for failure of antacid medication from three studies [22][23][24] showed a low association with oesophagogastric cancer (Table 2).…”

Section: Other Symptomsmentioning

confidence: 99%

Diagnostic value of symptoms of oesophagogastric cancers in primary care: a systematic review and meta-analysis

et al. 2015

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“…Due to a selection bias, the paper by Boldys et al [13] clearly overemphasizes the issue of young and asymptomatic patients with gastric cancer. The observational study by Boulton et al [18] seems to come closer to the real situation, as one out of 17 patients with gastric cancer (and with alarm symptoms) was less than 45 years old. In 2088 consecutive patients studied prospectively, we found 26 gastroesophageal cancers, two of which (7.6 %) indeed occurred in patients younger than 45 [12].…”

mentioning

confidence: 89%

“…The paper by Boulton-Jones et al [18] reviews the appropriateness and diagnostic yield of 1000 consecutive open-access referrals for upper gastrointestinal endoscopy in a UK district hospital. One-third of the procedures were found to be inappropriate according to the guidelines of the British Society of Gastroenterology (BSG).…”

mentioning

confidence: 99%

“…The paper by Boulton-Jones et al [18] indicates that one-third of gastroscopies were inappropriate according to the criteria issued by the British Society of Gastroenterology. The reported rate of inappropriate gastroscopy varies widely, from 5 % [25] to 49 % [21]; direct comparisons between studies are, however, difficult due to differences in the type of patients (inpatients vs. outpatients, patient age), in the type of criteria used, and the particular health care system under investigation.…”

mentioning

confidence: 99%

“…The answer based on the Polish paper [13] would be "No, but…", as the surprising results are mainly explained by selection bias. The answer to be drawn from the UK report [18] would be "Yes", as no cancer would be missed by relying on the criteria of age over 45 years and/or the presence of alarm symptoms. Increasing age is correlated with an increasing frequency of esophageal and gastric pathology, including cancer.…”

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confidence: 99%

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Is Age a Good Discriminator When Deciding Whether to Perform Gastroscopy?

Froehlich

2003

Endoscopy

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How to select patients for upper gastrointestinal endoscopy is a question of paramount clinical importance given the high prevalence of upper gastrointestinal symptoms (in particular of dyspepsia) and the relapsing nature of these complaints. Indeed, about 1 % [1, 2] to 1.8 % [3] of the population undergo gastroscopy each year. The decision to perform a diagnostic procedure such as gastroscopy must take into account the probability and net benefit of identifying disease; in contrast, the decision not to perform it must take into account the risk of missing significant disease [4] for which early, appropriate treatment can improve outcome.In this issue of Endoscopy, two original papers examine the use of upper gastrointestinal endoscopy with regard to patient age. Patient age has traditionally been an important factor for the clinician in deciding whether or not endoscopy should be done. Indeed, the probability of discovering a clinically relevant lesion, including cancer, at gastroscopy increases with age [5 -11]. A gradual increase in diagnostic yield for gastroscopy from 30 % at under 25 years to 61 % at over 65 years [12] has been reported.The paper by Boldys et al. [13] focuses on the relationship between gastric cancer, patient age, and the presence of alarm symptoms. The authors considered 860 patients who underwent a first gastroscopy at a secondary referral center for symptoms compatible with possible gastric cancer. Gastric cancers, most of which were advanced, were found in 83 patients (9.7 %). Of the patients with gastric cancer, 27 % did not have alarm symptoms, and as many as 24 % of them were younger than 45 years. Gastric cancer patients had more symptoms over a shorter period of time than patients without cancer. This paper reports a rate of gastric cancer which is 4 -8 times greater than the prevalence of this disease in Europe as a whole [14]. The main explanation for this provocative and unexpectedly high cancer rate is patient selection, as the prevalence of gastric cancer in Poland seems to be comparable to that in other European countries. Patient selection is significant in this paper for the following reasons. First, the patient sample under consideration represents only 1.3 % of all patients who had undergone gastroscopy at this center over the 10-year period of the study. The results relate to one among eight centers participating in a national gastric cancer program in Poland. Secondly, the centers were allowed to include no more than 100 consecutive patients per year. Thirdly, patient symptoms were already suggestive of possible gastric cancer. Nevertheless, at least in this highly selected population, one out of four patients with gastric cancer was under 45 years old or did not have any alarm symptoms. The authors therefore emphasize the need for endoscopy even in young patients with no alarm symptoms. This is in contrast to current guidelines [15 -17], and certainly cannot be translated into clinical practice as the patient sample in this study is overselected.The paper by Boulton-J...

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Diagnostic yield of upper endoscopy according to appropriateness: A systematic review

Zullo

Manta

Francesco

et al. 2019

Digestive and Liver Disease

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Open-Access Endoscopy: Are Age-Based Guidelines Justified? An Audit of Experience of 1000 Open-Access Endoscopies at a District General Hospital

Cited by 10 publications

References 20 publications

Diagnostic value of symptoms of oesophagogastric cancers in primary care: a systematic review and meta-analysis

Diagnostic value of symptoms of oesophagogastric cancers in primary care: a systematic review and meta-analysis

Is Age a Good Discriminator When Deciding Whether to Perform Gastroscopy?

Diagnostic yield of upper endoscopy according to appropriateness: A systematic review

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