Aims Endoscopic ultrasound (EUS) has been a well-established method for diagnosing and
treating inflammatory and malignant diseases of the gastrointestinal tract (GIT) for
years. Especially in interventional procedures, side-viewing echoendoscopes are used,
which provide limited endoluminal visualization. Consequently, many centers routinely
perform an esophagogastroduodenoscopy (EGD) prior to EUS to reliably differentiate
potential endoluminal pathologies. Due to limited evidence, the goal of the SafeSide
study is to critically assess the value of routine EGD prior to side-view EUS in terms
of diagnostic quality, patient safety, as well as economic and environmental aspects.
Methods This retrospective, single-center study included patients who underwent longitudinal
EUS in combination with EGD at the Interdisciplinary Endoscopy Department of the University
Medical Center Schleswig-Holstein, Campus Kiel. The primary endpoint was defined as
a clinically relevant diagnosis established via EGD that resulted in diagnostic or
therapeutic consequences. Secondary endpoints included sedation time, economic impact,
and ecological impact. Patients with known upper GIT disease, previous surgeries,
or pre-existing indications for EGD independent of EUS were excluded. Diagnostic criteria
for each method (EGD and EUS) were evaluated for a comparative cohort of 100 patients
each, using a calculation model.
Results In 2021, 1,094 patients were screened, with N=306 included in the study. In 55.6%
of the examinations, additional EGD enabled diagnosis of clinically relevant lesions,
and in 66.3%, non-relevant lesions of the upper GIT were identified. A significant
reduction in examination time and sedation requirements was observed with the combined
diagnostic approach compared to sequential examinations (p<0.001). Additionally, significant
reductions in personnel binding time (registration, examination, and recovery rooms)
and material consumption were detected (p<0.001). Further reductions were noted in
packaging and waste generation (p<0.001), in-house transport (p<0.001), and CO2 emissions
from travel distances for outpatient procedures (p<0.001).
Conclusions Routine EGD prior to EUS provides substantial additional benefit regarding luminal
diagnosis. The combination of both procedures improves treatment quality and patient
safety, while also optimizing economic and ecological impact.
