Gastroscopy for dyspeptic symptoms in patients <65 years has a low yield of clinically important findings: a retrospective study.

Autor:	Maracle B; Department of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada., Crick K; Office of Lifelong Learning & the Physician Learning Program, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 1C9, Canada., Novak K; Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada., Campbell-Scherer D; Office of Lifelong Learning & the Physician Learning Program, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 1C9, Canada.; Department of Family Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2T4, Canada., Veldhuyzen van Zanten S; Digestive Health Strategic Clinical Network, Alberta Health Services, AB, Canada.; Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB T6G 2X8, Canada., Sadowski DC; Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB T6G 2X8, Canada.
Jazyk:	angličtina
Zdroj:	Journal of the Canadian Association of Gastroenterology [J Can Assoc Gastroenterol] 2024 Feb 23; Vol. 7 (3), pp. 230-237. Date of Electronic Publication: 2024 Feb 23 (Print Publication: 2024).
DOI:	10.1093/jcag/gwae003
Abstrakt:	Background: Dyspepsia is a common, generally low-risk gastrointestinal condition. The American College of Gastroenterology and Canadian Association of Gastroenterology recommend avoiding gastroscopy in healthy patients <60 years old. Many dyspeptic patients can be effectively managed in primary care. This study aimed to determine: (1) the proportion of gastroscopies performed for dyspepsia among patients <65 years old with no alarm symptoms or clinically appropriate indications and (2) to determine the frequency of clinically actionable findings and dyspepsia-related healthcare utilization in the year following gastroscopy. Methods: Outpatient endoscopy reports were sampled and reviewed retrospectively from 2019 to -2021 in Edmonton, Alberta to identify gastroscopies performed for the indication of dyspepsia. Gastroscopies were considered low-risk for significant endoscopic findings if age <65, no alarm symptoms or other concerning indications, and insufficient evidence that first-line treatments and diagnostic approaches had been tried prior to gastroscopy. Clinically important findings were defined as those impacting management, not otherwise identifiable non-invasively. Results: Of the 358 reviewed gastroscopies for dyspepsia, 293 (81.8%) had no alarm symptoms, and 130 (36.3%) had no alarm symptoms or other appropriate indications. Clinically important findings were identified in 9 (6.9%) of the 130 low-risk cases. In the year following, one patient (1/130) visited the emergency department 3 times for their symptoms and no patients required hospital admission. No malignancies were detected. Conclusions: Many gastroscopies are performed on patients <65 years old with dyspepsia, even when they lack alarm symptoms or other clinical indications, despite recommendations against this practice and low procedure yield. Strategies to improve the uptake of current guidelines may optimize endoscopy resource utilization. Competing Interests: The author(s) declare(s) that there is no conflict of interest regarding the publication of this article. (© The Author(s) 2024. Published by Oxford University Press on behalf of the Canadian Association of Gastroenterology.)
Databáze:	MEDLINE
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