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Original research
Diagnostic yield from symptomatic gastroscopy in the UK: British Society of Gastroenterology analysis using data from the National Endoscopy Database
  1. David Robert Beaton1,2,
  2. Linda Sharp2,
  3. Liya Lu2,
  4. Nigel J Trudgill3,
  5. Mo Thoufeeq4,
  6. Brian D Nicholson5,
  7. Peter Rogers6,
  8. James Docherty7,
  9. Anna Jenkins8,
  10. Allan John Morris9,
  11. Thomas Rösch10,
  12. Matthew D Rutter2,11
  1. 1Northumbria Healthcare NHS Foundation Trust, North Shields, UK
  2. 2Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
  3. 3Department of Gastroenterology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
  4. 4Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
  5. 5University of Oxford Department of Primary Care Health Sciences, Oxford, UK
  6. 6Weblogik, Ipswich, UK
  7. 7Department of Surgery, Raigmore Hospital, Inverness, UK
  8. 8Royal College of Physicians, London, UK
  9. 9Gastroenterology, Glasgow Royal Infirmary, Glasgow, UK
  10. 10Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf Department of Interdisciplinary Endoscopy, Hamburg, Germany
  11. 11Gastroenterology, North Tees and Hartlepool NHS Foundation Trust, Hartlepool, UK
  1. Correspondence to Dr David Robert Beaton, Northumbria Healthcare NHS Foundation Trust, North Shields, TS19 8PE, UK; dbeaton1{at}nhs.net

Abstract

Objective This national analysis aimed to calculate the diagnostic yield from gastroscopy for common symptoms, guiding improved resource utilisation.

Design A cross-sectional study was conducted of diagnostic gastroscopies between 1 March 2019 and 29 February 2020 using the UK National Endoscopy Database. Mixed-effect logistic regression models were used, incorporating random (endoscopist) and fixed (symptoms, age and sex) effects on two dependent variables (endoscopic cancer; Barrett’s oesophagus (BO) diagnosis). Adjusted positive predictive values (aPPVs) were calculated.

Results 382 370 diagnostic gastroscopies were analysed; 30.4% were performed in patients aged <50 and 57.7% on female patients. The overall unadjusted PPV for cancer was 1.0% (males 1.7%; females 0.6%, p<0.01). Other major pathology was found in 9.1% of procedures, whereas 89.9% reported only normal findings or minor pathology (92.5% in females; 94.6% in patients <50).

Highest cancer aPPVs were reached in the over 50s (1.3%), in those with dysphagia (3.0%) or weight loss plus another symptom (1.4%). Cancer aPPVs for all other symptoms were below 1%, and for those under 50, remained below 1% regardless of symptom. Overall, 73.7% of gastroscopies were carried out in patient groups where aPPV cancer was <1%.

The overall unadjusted PPV for BO was 4.1% (males 6.1%; females 2.7%, p<0.01). The aPPV for BO for reflux was 5.8% and ranged from 3.2% to 4.0% for other symptoms.

Conclusions Cancer yield was highest in elderly male patients, and those over 50 with dysphagia. Three-quarters of all gastroscopies were performed on patients whose cancer risk was <1%, suggesting inefficient resource utilisation.

  • GASTROSCOPY
  • CANCER
  • DIAGNOSTIC AND THERAPEUTIC ENDOSCOPY
  • BARRETT'S OESOPHAGUS

Data availability statement

Data are available upon reasonable request. Stata Do files available upon reasonable request.

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Data availability statement

Data are available upon reasonable request. Stata Do files available upon reasonable request.

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Footnotes

  • X @BrianDNicholson, @thomas_rosch

  • Contributors DRB, LS and MDR designed the study, drafted and revised the manuscript, with input from NJT, JD, MT, BDN, TR and AJM. AJM supported data acquisition and PR extracted data from the National Endoscopy Database, LL provided input with data modelling and analysis. DRB analysed the data and acted as guarantor for the work and conduct of the study. All authors approved the manuscript for submission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests All authors have completed the ICMJE uniform disclosure form at http://www.icmje.org/disclosure-of-interest/http://www.icmje.org/disclosure-of-interest/. LS has unrestricted project grants from 3D-Matrix and Medtronic. TR is deputy editor at Gut journal. All other authors declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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