Do Low-Risk Patients With Dyspepsia Need a Gastroscopy? Use of Gastroscopy for Otherwise Healthy Patients With Dyspepsia

Jennifer B Halasz; Kelly W Burak; Shawn K Dowling; Brenna Murray; Jennifer Williams; Tarun Misra; Sander J Veldhuyzen van Zanten; Gilaad G Kaplan; Mark Swain; Kerri L Novak

doi:10.1093/jcag/gwab017

Do Low-Risk Patients With Dyspepsia Need a Gastroscopy? Use of Gastroscopy for Otherwise Healthy Patients With Dyspepsia

J Can Assoc Gastroenterol. 2021 Jul 5;5(1):32-38. doi: 10.1093/jcag/gwab017. eCollection 2022 Feb.

Authors

Jennifer B Halasz¹, Kelly W Burak^{2

3}, Shawn K Dowling^{3

4}, Brenna Murray³, Jennifer Williams⁵, Tarun Misra⁵, Sander J Veldhuyzen van Zanten⁶, Gilaad G Kaplan⁵, Mark Swain⁵, Kerri L Novak⁵

Affiliations

¹ Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
² Department of Medicine, Division of Gastroenterology Hepatology, University of Calgary, Calgary, Alberta, Canada.
³ Physician Learning Program, Continuing Medical Education and Professional Development, University of Calgary, Calgary, Alberta, Canada.
⁴ Department of Emergency Medicine, University of Calgary, Calgary, Alberta, Canada.
⁵ Department of Medicine, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada.
⁶ Department of Medicine, Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada.

Abstract

Background: Choosing Wisely Canada (CWC) recommends not to perform gastroscopy for dyspepsia in otherwise healthy adults less than 55 years of age (2014). The aim of this study was to evaluate the use of gastroscopy in a young, healthy population with uncomplicated dyspepsia.

Methods: A retrospective review of gastroscopies completed during 3-month periods in 2015, 2016, and 2017 identified all patients undergoing gastroscopy for the primary indication of dyspepsia. Low-risk patients for dyspepsia were defined as adults, aged 18 to 54 years without alarm symptoms, comorbidities and/or abnormal imaging findings or laboratory values. Gastroscopy and pathology reports were reviewed to identify clinically actionable findings. Clinical outcomes were followed to December 31, 2018 including gastroenterology referrals, emergency room visitation and hospitalization.

Results: Among 1358 patients having a gastroscopy for dyspepsia, 480 (35%) were low-risk patients. Sixteen patients 3.3% (16/480) had a clinically actionable result found on gastroscopy or biopsy. No malignant lesions were detected. Low-risk patients were followed up for an average of 2.75 years, 8% (39/480) visited the emergency department (ED), 1% (3/480) of patients were admitted to hospital and 12% (59/480) of patients were re-referred for a dyspepsia-related concern.

Interpretation: A high rate of low yield, high cost, invasive endoscopic investigations were performed in this population of otherwise healthy patients under age 55 years. These data suggest limited uptake of current recommendations against the routine use of gastroscopy to investigate dyspepsia.

Keywords: Choosing Wisely; Dyspepsia; Gastroscopy.