Reassessing the value of gastroscopy for the investigation of dyspepsia

Ching, Hey-Long; Hale, Melissa F; Sidhu, Reena; McAlindon, Mark E.

doi:10.1136/flgastro-2017-100838

Cited by 15 publications

(15 citation statements)

References 35 publications

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“…In the United States, an increase in 50% of gastroscopy utilisation was estimated within the space of a decade between 2000 and 2010[ 20 ]. However, gastroscopy is an uncomfortable procedure[ 16 , 21 , 22 ] and the majority of findings do not significantly affect management[ 23 ]. This would suggest a role for a well-tolerated, non-invasive alternative that could select the minority of patients who need upper gastrointestinal biopsies or endoscopic therapy.…”

Section: Discussionmentioning

confidence: 99%

“…The technology to biopsy lesions has been reported but remains in the experimental phase[ 48 ]. However, whilst most endoscopists have a low threshold for taking biopsies, the use of non-invasive tests for Helicobacter pylori might reduce this and our experience of investigating patients with dyspepsia is that biopsies only increased diagnostic yield by 2.4%[ 23 ].…”

Section: Discussionmentioning

confidence: 99%

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Upper gastrointestinal tract capsule endoscopy using a nurse-led protocol: First reported experience

Ching

Healy

Thurston

et al. 2018

WJG

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AIMTo test the feasibility and performance of a novel upper gastrointestinal (GI) capsule endoscope using a nurse-led protocol.METHODSWe conducted a prospective cohort analysis of patients who declined gastroscopy (oesophagogastroduodenoscopy, OGD) but who consented to upper GI capsule endoscopy. Patients swallowed the upper GI capsule following ingestion of 1 liter of water (containing simethicone). A series of positional changes were used to exploit the effects of water flow and move the upper GI capsule from one gravity-dependent area to another using a nurse-led protocol. Capsule transit time, video reading time, mucosal visualisation, pathology detection and patient tolerance was evaluated.RESULTSFifty patients were included in the study. The mean capsule transit times in the oesophagus and stomach were 28 s and 68 min respectively. Visualisation of the following major anatomical landmarks was achieved (graded 1-5: Poor to excellent): Oesophagus, 4.8 (± 0.5); gastro-oesophageal junction (GOJ), 4.8 (± 0.8); cardia, 4.8 (± 0.8); fundus, 3.8 (± 1.2); body, 4.5 (± 1); antrum, 4.5 (± 1); pylorus, 4.7 (± 0.8); duodenal bulb, 4.7 (± 0.7); second part of the duodenum (D2), 4.7 (± 1). The upper GI capsule reached D2 in 64% of patients. The mean video reading time was 48 min with standard playback mode and 20 min using Quickview (P = 0.0001). No pathology was missed using Quickview. Procedural tolerance was excellent. No complications were seen with the upper GI capsule.CONCLUSIONThe upper GI capsule achieved excellent views of the upper GI tract. Future studies should compare the diagnostic accuracy between upper GI capsule and OGD.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Upper gastrointestinal tract capsule endoscopy using a nurse-led protocol: First reported experience

Ching

Healy

Thurston

et al. 2018

WJG

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“…Many, if not all, dyspepsia guidelines offer strict advice of when to use upper GI endoscopies. Despite these recommendations, there is a global overuse of upper GI endoscopies, which mirrors poor adherence to practice guidelines[1,3,4,17]. Reasons for non-adherence are manifold and include a disconnect between guidelines and local situation, failure to reach the target audience, or the absence of a specific implementation strategy.…”

Section: Guideline Implementationmentioning

confidence: 99%

Prevention of overuse: A view on upper gastrointestinal endoscopy

Jong¹,

Lantinga²,

Joostrenth³

2019

WJG

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Many upper gastrointestinal (GI) endoscopies worldwide are performed for inappropriate indications. This overuse of healthcare negatively affects healthcare quality and puts pressure on endoscopy services. Dyspepsia is one of the most common inappropriate indications for upper GI endoscopy as diagnostic yield is low. Reasons for untimely referral are: unfamiliarity with dyspepsia guidelines, uncertainty about etiology of symptoms, and therapy failure. Unfiltered open-access referrals feed upper GI endoscopy overuse. This review highlights strategies applied to diminish use of upper GI endoscopies for dyspepsia. First, we describe the impact of active guideline implementation. We found improved guideline adherence, but resistance was encountered in the process. Secondly, we show several forms of clinical assessment. While algorithm use reduced upper GI endoscopy volume, effects of referral assessment of individual patients were minor. A third strategy proposed Helicobacter pylori test and treat for all dyspeptic patients. Many upper GI endoscopies can be avoided using this strategy, but outcomes may be prevalence dependent. Lastly, empirical treatment with Proton pump inhibitors achieved symptom relief for dyspepsia and avoided upper GI endoscopies in about two thirds of patients. Changing referral behavior is complex as contributing factors are manifold. A collaboration of multiple strategies is most likely to succeed.

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“…Whether the gastroscopy needs to be undertaken in the first place is a question addressed in the paper by Ching and colleagues2 from Sheffield. The observations provide a powerful argument for commissioners and providers of endoscopy to reduce the ritualised pathway of referring over 55 year olds with dyspepsia.…”

Section: Gastric Biopsies In the Dyspeptic Patient: Challenging The Omentioning

confidence: 99%

Orthopraxy, not orthodoxy

Emmanuel

2017

Frontline Gastroenterol

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Reassessing the value of gastroscopy for the investigation of dyspepsia

Cited by 15 publications

References 35 publications

Upper gastrointestinal tract capsule endoscopy using a nurse-led protocol: First reported experience

Upper gastrointestinal tract capsule endoscopy using a nurse-led protocol: First reported experience

Prevention of overuse: A view on upper gastrointestinal endoscopy

Orthopraxy, not orthodoxy

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