The yield of upper gastrointestinal endoscopy in patients below 60 years and without alarm symptoms presenting with dyspepsia

Abstract

Background and aims

Upper gastrointestinal (GI) endoscopy is frequently performed in patients with upper abdominal symptoms. Although guidelines recommend withholding an endoscopy in the absence of alarm symptoms, dyspeptic symptoms remain a predominant indication for endoscopy. We aimed to investigate the yield of upper GI endoscopy in patients with low-risk dyspeptic symptoms.

Methods

We conducted an analysis in a prospectively maintained endoscopy reporting database. We collected the results of all upper GI endoscopy procedures between 2015 and 2019 that was performed in adult patients aged <60 years with dyspeptic symptoms. Patients with documented alarm symptoms were excluded. We categorized endoscopic findings into major and minor endoscopic findings.

Results

We identified 26,440 patients with dyspeptic symptoms who underwent upper GI endoscopy. A total of 13,978 patients were considered low-risk and included for analysis (median age 46 years, interquartile range (IQR) [36–53], 62% female). In 11,353 patients (81.2%), no endoscopic abnormalities were detected. Major endoscopic findings were seen in 513 patients (3.7%) and minor endoscopic findings in 2178 patients (15.6%). Endoscopic findings indicative of upper GI cancer were reported in 47 patients (0.3%), including 16 (0.1%) oesophageal, 28 (0.2%) gastric and 5 (0.04%) duodenal lesions. Despite an initial unremarkable endoscopy result, 1015 of 11,353 patients (8.9%) underwent a follow-up endoscopy after a median of 428 days [IQR 158–819]. This did not lead to the additional identification of malignancy.

Conclusions

The yield of upper GI endoscopy in low-risk (<60 years, no alarm symptoms) patients with dyspepsia is very limited. This study further supports a restrictive use of upper GI endoscopy in these patients.

Keywords:

• Dyspeptic symptoms
• dyspepsia
• upper gastrointestinal endoscopy
• endoscopic outcomes
• low-risk patients
• gastrointestinal malignancies

Disclosure statement

F. Theunissen: no conflicting interests.

M.A. Lantinga: no conflicting interests.

P.C.J. ter Borg: no conflicting interests.

R.J. Ouwendijk: Research grants from Janssen Netherlands and the Coolsingel Foundation.

M.J. Bruno: Boston Scientific; Consultant, support for industry and investigator initiated studies; Cook Medical; Consultant, support for industry and investigator initiated studies; Pentax Medical; support for investigator initiated studies; Mylan; support for investigator initiated studies; ChiRoStim; support for investigator initiated studies.

P.D. Siersema: Research grants from Norgine, Pentax, Microtech, Yakult and Motus GI (ongoing); Advisory Board of Motus GI and Boston Scientific.