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Objective Comparing the referral diagnosis as an indication for EGD with final histological diagnosis, and to assess whether it was justified to perform these endoscopies in our patients. Methods Retrospective analysis of patients who underwent gastroscopy with biopsy in the period from 1.1.2016. to 29.02.2020 at the Clinical Hospital Center Zagreb. The study did not include foreign body removal procedures, follow up endoscopies and endoscopies for the purpose of placing medical orthopedic aids. We have described the symptoms leading to referral for endoscopy, as well as their average duration prior to endoscopy. We analyzed the correlation between referral and final histological diagnosis. Results In a cohort of a total of 100 patients, the most common indication for gastroscopy in 24/100 (24%) was abdominal pain, and in approximately half of them (13/24, 54.2%) the histological cause of the discomfort was found (gastritis in 12 and celiac disease in 1). Of the 20 gastroscopies performed on suspicion of gastritis, in 12/20 (60%) pathological substrate was found (9 gastritis, 2 eosinophilic esophagitis, 1 celiac disease). Due to celiac disease suspicion, we endoscopied 18 patients, of whom in 10 (55.6%) celiac disease was histologically confirmed. In 6/11 (54.5%) patients with dyspeptic symptoms diagnosis of gastritis was made after the endoscopy. In almost half of the patients, the pathohistological finding was normal. From 52 pathological findings ; 31/52 (59.6%) corresponds to gastritis, 12/52 (23.1%) to celiac disease, 5/52 (9.6%) to eosinophilic esophagitis, and in 2 patients (3.8%) esophageal varices and stomach polyps were found. The average duration of discomfort was 10 months and 26 days, while the largest number of patients ; 17 of them had symptoms for a year, 16 had problems for 6 months, 9 had symptoms for 2 years, and 8 had symptoms for 1 and 3 months, respectively before the endoscopy. It should be noted that 10 were asymptomatic and were referred for endoscopy on the basis of pathological laboratory findings (complete blood count, iron, antibodies to tissue transglutaminase) or specific anamnesis (body weight loss, failure to thrive). Endoscopy completion rate by entering into the distal end of duodenum was 100%. We did not record any complications. Conclusion Considering the nonspecific symptoms of the disease that greatly correlate with functional difficulties the number of negative findings is not surprising. But since gastroscopy is the most sensitive method of confirmation/exclusion of the disease itself it is clear that a high number of negative findings point to the necessity of developing clearer guidelines to avoid unnecessary endoscopies. Furthermore, comparing our results with the results of similar foreign studies we can say that we are within the world average and that this indeed is a global problem that requires team effort especially at a time when the number of endoscopic procedures grows rapidly every day due to increased endoscopic possibilities. |
