Introduction The optimum role for gastroscopy (OGD) in managing dyspepsia and detecting oesophagogastric cancer (OG-Ca) is controversial. UK general practitioners (GPs) serve a gatekeeper role in selecting dyspeptic patients for OGD. We reported that variation in rates of OGD at the level of GP practise populations is associated with OG-Ca outcome, specifically that low rates are related to risk of poor outcome. We wished to show that GP practises with low OGD rates are likely to be operating more selective referral practise with higher yield of serious pathology.
Methods GP practises with ≥1 incident case of OG-Ca were selected, as described.[1.2] Using a two-year download of HES data we identified all elective OGD procedures and obtained practise data to calculate age-sex adjusted OGD rates. Practices were divided into OGD rate tertiles (Low, Medium or High). An algorithm was developed to analyse coded diagnoses for first OGDs, identifying most “serious” condition: (1) OG-Ca, (2) Major acid-peptic diseases, (3) Minor findings (e.g. gastritis), (4) Benign GI neoplasms, (5) Upper GI symptom codes, (6) Miscellaneous (all others). We compared age and proportions with serious disease (categories: 1–2) across the GP practise tertiles.
Results 587,256 patients had elective OGD from 6,513 practises serving an adult population of c.39 million. Overall, yield of OG-Ca was 2.1%, major acid-peptic diseases 11.6% and the remaining 86.3% were mainly minor pathologies or symptom codes. Mean OGD rate for Low, Middle, High practises: 4.4 vs 8.1 vs 12.9 per 1,000 population. No difference in age distribution of populations across tertiles. Mean age of patients undergoing OGD was highest for low tertile practises (60.2 vs 59.5 vs 58.4 yrs; p < 0.001) which had highest yield of serious disease: 16,595/108,679 (15.3%) vs 28,177/203,771 (13.9%) vs 36,026/274,806 (13.1%) (p < 0.001).
Conclusion Low referring practises appear to target slightly older patients and achieve higher yield of serious disease. Although higher yield may be more consistent with current guidelines, it may also indicate an increased risk of referral at a later stage in the disease process and of poorer OG-Ca outcome.
Disclosure of Interest None Declared.
Shawihdi, M., et al. Gastroscopy rate in English general practise populations: association with outcome for oesophagogastric cancer. Gut, 2012. 61(Suppl 2):A19.
Shawihdi, M., et al. Emergency Hospital Admission as a Route for Oesophagogastric Cancer Diagnosis: A Marker of Poor Outcome and a Candidate Quality Indicator for Local Services. Gastroenterology, 2011. 140( 5, Supplement 1):S207.
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