Appropriateness and diagnostic yield of upper gastrointestinal endoscopy: need to improve patient selection for greater sustainability

Aims The diagnosis of most upper gastrointestinal (GI) tract disorders is mainly clinical, with specific indications for digestive endoscopy. Adherence to guidelines about the selection of eligible patients for upper GI endoscopy is cost-effective in an open-access system [1] and the diagnostic yield of appropriate endoscopies is higher compared with inappropriate procedures [2]. However, in the era of sustainable medicine, literature lacks observational studies aimed at evaluating the endoscopic appropriateness in an open-access systems. The aim of the study is to investigate the appropriateness of prescriptions for upper-GI endoscopy, including the associated diagnostic yield.

Methods This monocentric observational study was conducted by enrolling all consecutive patients undergoing upper-GI endoscopy. A detailed interview was performed in every patient underwent to upper-GI endoscopy to investigate symptoms, dietary habits, gastrointestinal history and other significative clinical information before the endoscopic examination. The appropriateness of the endoscopy was defined according to the ASGE guidelines [3]. After the endoscopic examination, the diagnostic yield, defined as a relevant diagnosis that could change the clinical history of patients, was evaluated.

Results A total of 271 patients were enrolled. Most of them were female (146, 53.8%), mean age 58.2 yrs (range 20-92). The main prescriber was the general practitioner (GP) (171, 63.1%), followed by gastroenterologists (58, 21.4%) and other specialists (41, 15.1%). The most frequent endoscopic findings were gastritis and/or duodenitis (102, 37.6%), followed by normal findings (40, 14.7%), minor premalignant lesions (30, 11%) and major premalignant lesions (22, 8.1%) and esophagitis (22, 8.1%), while new diagnosis of neoplastic lesions were 7 (2.5%). The overall appropriateness of prescriptions was 43.1% (117 exams). Considering the different appropriateness of indication among the three categories of prescribers, gastroenterologists had a higher percentage of appropriate prescriptions (47/58, 81%), followed by other specialists (19/41, 46.3%) and GPs (51/171, 29.8%) (p<0.0001). Forty-seven out of 154 (30.5%) of the patients with an inappropriate indication had undergone an upper-GI endoscopy within the previous 5 years, with findings that did not require follow-up [4]. The overall diagnostic yield was 68 out of 271 exams (25%), with significant differences between appropriate and inappropriate exams (56/117, 47.8% vs 12/154, 7.7%, p<0.0001).

Conclusions Adherence to guidelines for the appropriateness of upper GI endoscopy is confirmed to be more effective, including the added benefit from the diagnostic yield of appropriate upper GI endoscopies. These results suggest that if proper education of practitioners were implemented, a better endoscopy-utilization would be expected.

Publication History

Article published online:
27 March 2025

• References

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• 2 Rodrìguez-de-Santiago E. et al. Digestive findings that do not require endoscopic surveillance – Reducing the burden of care: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement Endoscopy. 2020.
• 3 Early DS. et al. ASGE standards of practice committee: appropriate use of GI endoscopy Gastrointest Endosc. 2012.
• 4 Zullo A. et al. Diagnostic yield of upper endoscopy according to appropriateness: A systematic review Dig Liver Dis. 2019.