Age Cutoff and Yield of Prompt Esophagogastroduodenoscopy to Detect Malignancy in Vietnamese with Upper Gastrointestinal Symptoms: An Endoscopic Database Review of 472,744 Patients from 2014 to 2019

Background and Aims. Age cutoff is an important factor in deciding whether esophagogastroduodenoscopy (EGD) is necessary for patients presenting with upper gastrointestinal symptoms. However, the cutoff value is significantly different across populations. We aimed to determine the age cutoff for EGD that assures a low rate of missing upper gastrointestinal malignancy (UGIM) and to assess the yield of prompt EGD in Vietnamese patients presenting with upper gastrointestinal symptoms. Methods. All EGDs performed in outpatients during a 6-year period (2014–2019) at a tertiary hospital that provided an open-access endoscopy service were retrospectively reviewed. Repeat or surveillance EGDs were excluded. Different age cutoffs were evaluated in terms of their prediction of the absence of UGIM. The yield of endoscopy to detect one malignancy (YoE) was also calculated. Results. Of 472,744 outpatients presenting with upper gastrointestinal symptoms, there were 2198 (0.4%) patients with UGIM. The median age and male-to-female ratio of patients with UGIMs were 57.9 ± 12.5 years and 2.5 : 1, respectively. The YoEs in patients <40, 40–60, and >60 years of age were <1, 1–10, and >10 per 1000 EGDs, respectively. The age cutoffs of 30 years in females and 35 years in males could detect 98.2% (95% CI: 97.7%–98.8%) of UGIM cases with a YoE of about 1 per 1000 EGDs. Conclusions. The age cutoff for EGD in Vietnamese should be lower than that recommended by current international guidelines. The strategy of prompt EGD showed a low YoE, and its cost-effectiveness requires further investigation.

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A One-Year Economic Evaluation of Six Alternative Strategies for the Management of Uninvestigated Upper Gastrointestinal Symptoms in Canadian Primary Care

Canadian Journal of Gastroenterology ◽

10.1155/2010/379583 ◽

2010 ◽

Vol 24 (8) ◽

pp. 489-498 ◽

Cited By ~ 7

Author(s):

Alan N Barkun ◽

Ralph Crott ◽

Carlo A Fallone ◽

Wendy A Kennedy ◽

Jean Lachaine ◽

...

Keyword(s):

Cost Effectiveness ◽

Proton Pump Inhibitor ◽

Proton Pump ◽

Gastrointestinal Symptoms ◽

Cost Effective ◽

Upper Gastrointestinal Symptoms ◽

Management Approaches ◽

The Cost ◽

Relevant Range ◽

Upper Gastrointestinal

BACKGROUND: The cost-effectiveness of initial strategies in managing Canadian patients with uninvestigated upper gastrointestinal symptoms remains controversial.OBJECTIVE: To assess the cost-effectiveness of six management approaches to uninvestigated upper gastrointestinal symptoms in the Canadian setting.METHODS: The present study analyzed data from four randomized trials assessing homogeneous and complementary populations of Canadian patients with uninvestigated upper gastrointestinal symptoms with comparable outcomes. Symptom-free months, quality-adjusted life-years (QALYs) and direct costs in Canadian dollars of two management approaches based on the Canadian Dyspepsia Working Group (CanDys) Clinical Management Tool, and four additional strategies (two empirical antisecretory agents, and two prompt endoscopy) were examined and compared. Prevalence data, probabilities, utilities and costs were included in a Markov model, while sensitivity analysis used Monte Carlo simulations. Incremental cost-effectiveness ratios and cost-effectiveness acceptability curves were determined.RESULTS: Empirical omeprazole cost $226 per QALY ($49 per symptom-free month) per patient. CanDys omeprazole and endoscopy approaches were more effective than empirical omeprazole, but more costly. Alternatives using H2-receptor antagonists were less effective than those using a proton pump inhibitor. No significant differences were found for most incremental cost-effectiveness ratios. As willingness to pay (WTP) thresholds rose from $226 to $24,000 per QALY, empirical antisecretory approaches were less likely to be the most cost-effective choice, with CanDys omeprazole progressively becoming a more likely option. For WTP values ranging from $24,000 to $70,000 per QALY, the most clinically relevant range, CanDys omeprazole was the most cost-effective strategy (32% to 46% of the time), with prompt endoscopy-proton pump inhibitor favoured at higher WTP values.CONCLUSIONS: Although no strategy was the indisputable cost-effective option, CanDys omeprazole may be the strategy of choice over a clinically relevant range of WTP assumptions in the initial management of Canadian patients with uninvestigated dyspepsia.

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THE GASTROPACK SYSTEM AS A MODEL FOR EGD APPROPRIATENESS IN PATIENTS WITH UPPER GASTROINTESTINAL SYMPTOMS: A COMPARISON WITH THE OPEN ACCESS SYSTEM

10.1055/s-0040-1704574 ◽

2020 ◽

Author(s):

L Ceroni ◽

F Lodato ◽

C Fabbri ◽

P Tubertini ◽

M Biselli ◽

...

Keyword(s):

Open Access ◽

Gastrointestinal Symptoms ◽

Access System ◽

Upper Gastrointestinal Symptoms ◽

Upper Gastrointestinal

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Faculty Opinions recommendation of A small particle size diet reduces upper gastrointestinal symptoms in patients with diabetic gastroparesis: a randomized controlled trial.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718234590.793489907 ◽

2014 ◽

Author(s):

Klaus Bielefeldt

Keyword(s):

Particle Size ◽

Randomized Controlled Trial ◽

Small Particle ◽

Controlled Trial ◽

Gastrointestinal Symptoms ◽

Diabetic Gastroparesis ◽

Small Particle Size ◽

Randomized Controlled ◽

Upper Gastrointestinal Symptoms ◽

Upper Gastrointestinal

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Effects of coexisting upper gastrointestinal symptoms on daily life and quality of life in patients with gastroesophageal reflux disease symptoms

Esophagus ◽

10.1007/s10388-020-00801-1 ◽

2021 ◽

Author(s):

Kimio Isshi ◽

Hiroto Furuhashi ◽

Akio Koizumi ◽

Koji Nakada

Keyword(s):

Quality Of Life ◽

Gastroesophageal Reflux Disease ◽

Gastroesophageal Reflux ◽

Reflux Disease ◽

Daily Life ◽

Gastrointestinal Symptoms ◽

Disease Symptoms ◽

Upper Gastrointestinal Symptoms ◽

Upper Gastrointestinal

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High rates of gastroesophageal cancers in patients with dyspepsia undergoing upper gastrointestinal endoscopy in Uganda

Endoscopy International Open ◽

10.1055/a-1480-7231 ◽

2021 ◽

Vol 09 (07) ◽

pp. E997-E1000

Author(s):

Ronald Mbiine ◽

Cephas Nakanwagi ◽

Olivia Kituuka

Keyword(s):

Positive Association ◽

Referral Hospital ◽

Outcome Variable ◽

Mulago Hospital ◽

Upper Gastrointestinal Endoscopy ◽

Female Ratio ◽

Mulago National Referral Hospital ◽

Male To Female ◽

Upper Gastrointestinal ◽

National Referral Hospital

Abstract Background and study aims Dyspepsia is the most common presenting symptom in the gastrointestinal clinic of Mulago National Referral hospital. The etiology is essentially not fully described in our patient population. This study was therefore conducted to establish the causes of dyspepsia based on endoscopic diagnosis among patients with dyspepsia seeking care at the National Referral hospital of Uganda. Patients and methods This retrospective study conducted in the endoscopy unit of Mulago hospital reviewed 356 patient endoscopy reports spanning January 2018 to July 2020 with a focus on those with a referral indication of dyspepsia. Age and sex were the independent variables of interest while the endoscopy findings as reported by the endoscopist were the outcome variable of interest. Results Of the 356 endoscopy reports reviewed, 159 met the inclusion criterion of dyspepsia as the indication. Participant mean age was 47.7 years (± 16.53) with the majority (25.79 %) in the fifth decade while the male to female ratio was 1. The majority of patients had organic dyspepsia (90.57 %) while the commonest finding was gastritis 69 (43.4 %). Gastroesophageal cancers represented (18) 11.32 % of all findings. There was a positive association between age > 50 years with gastroesophageal cancers (7.639) as well as age < 50 years and functional dyspepsia (2.794); however, all these were not statistically significant (P = 0.006 and (P = 0.095, respectively). Conclusions Organic/structural dyspepsia comprises over 90 % of investigated dyspepsia with 11 % comprising cancer among patients seeking endoscopy at the National Referral Hospital of Uganda.

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