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Diagnostic upper GI endoscopy: can less mean more?
  1. Ian Penman
  1. Centre for Liver & Digestive Disorders, Royal Infirmary Edinburgh, Edinburgh, UK
  1. Correspondence to Dr Ian Penman, Centre for Liver & Digestive Disorders, Royal Infirmary Edinburgh, Edinburgh, Midlothian, UK; ian.penman{at}

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In the UK and other western countries, dyspepsia and upper gastrointestinal (GI) symptoms are common and usually lead to upper GI endoscopy (OGD), yet the incidence of non-cardia gastric cancer is relatively low and declining.1 Despite this, the widespread use of ‘test and treat’ for Helicobacter pylori, and guidelines recommending against OGD for young patients with dyspepsia in the absence of ‘alarm’ features, diagnostic OGD remains the cornerstone of assessing such patients.

In Gut, Beaton et al present an analysis of the UK National Endoscopy Database (NED).2 NED captures automatic uploads from endoscopy reporting software systems from 95% of endoscopy units in the UK and is a powerful, validated resource for audit, research and quality assurance.3 The authors investigated 382 370 first diagnostic OGDs performed for symptoms in the 12 months up to March 2020. The primary aim was to study the diagnostic yield overall and by specific symptoms, as well as by age and sex. The positive predictive value (PPV) of different symptoms for cancer or Barrett’s oesophagus was calculated in different patient groups with the goal of trying to identify opportunities to refine referral pathways and improve service capacity. Patients with multiple …

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  • Contributors I am the sole author of this work.

  • 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 None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.

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