An Assessment of the Potential Value of Endoscopic Ultrasound as a Cost-Minimizing Tool in Dyspeptic Patients with Persistent Symptoms

 

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Study Aims: To quantify resource utilization in dyspeptic patients with persistent symptoms and to determine whether using both the endoscopic and ultrasound capabilities of endoscopic ultrasound could reduce costs.

Methods: Consecutive patients with persistent dyspepsia, after a minimum 1-month trial of acid suppression, underwent endoscopic ultrasound (EUS) and upper endoscopy using the GF-UM20 echo endoscope. Assuming EUS could replace imaging tests which had been requested in addition to upper endoscopy, the hypothetical costs of the EUS-based and upper endoscopy-based strategies were compared.

Results: 116 patients with persistent dyspepsia underwent EUS, of whom 64.6 % had ≥ 2 imaging procedures, most commonly computed tomography (CT) (70.6 %) and abdominal ultrasound (64.7 %). The number of tests did not correlate strongly with any demographic variables. The fiberoptic echo endoscope provided an adequate endoscopic and ultrasound examination but was damaged by retroflexion. Direct hospital costs were lowest for the EUS-based strategy. Total avoidable cost for 116 patients was $ 4137 to $ 14 121 (or $ 36 to $ 122 per patient), depending on whether upper endoscopy was performed in the non-EUS strategies.

Conclusions: Patients with persistent dyspepsia may undergo multiple abdominal imaging procedures. Clinical variables do not predict the need for additional testing. An EUS-based strategy may reduce overall costs if it prevents additional testing.

References

• 1 Jones R, Lydeard S. Prevalence of symptoms of dyspepsia in the community.  BMJ. 1989;  298 30-32
  PubMedGoogle Scholar
• 2 Talley N J, Silverstein M D, Agreus L, et al. AGA technical review: evaluation of dyspepsia. American Gastroenterological Association.  Gastroenterology. 1998;  114 582-595
  CrossrefPubMedGoogle Scholar
• 3 Talley N J, Weaver A L, Zinsmeister A R. Impact of functional dyspepsia on quality of life.  Dig Dis Sci. 1995;  40 584-589
  PubMedGoogle Scholar
• 4 Bytzer P, Hansen J M, Schaffalitzky de Muckadell O B. Empirical H2-blocker therapy or prompt endoscopy in management of dyspepsia.  Lancet. 1994;  343 811-816
  CrossrefPubMedGoogle Scholar
• 5 Silverstein M D, Petterson T, Talley N J. Initial endoscopy or empirical therapy with or without testing for Helicobacter pylori for dyspepsia: a decision analysis.  Gastroenterology. 1996;  110 72-83
  PubMedGoogle Scholar
• 6 Agreus L, Svardsudd K, Nyren O, et al. Irritable bowel syndrome and dyspepsia in the general population: overlap and lack of stability over time.  .  Gastroenterology. 1995;  109 671-680
  CrossrefPubMedGoogle Scholar
• 7 Jones R. What happens to patients with non-ulcer dyspepsia after endoscopy?.  Practitioner. 1978;  232 75-76
  PubMedGoogle Scholar
• 8 Longstreth G F. Long-term costs after gastroenterology consultation with endoscopy versus radiography in dyspepsia.  Gastrointest Endosc. 1992;  38 23-26
  PubMedGoogle Scholar
• 9 Morris C, Chapman R, Mayou R. The outcome of unexplained dyspepsia. A questionnaire follow-up study of patients after endoscopy.  J Psychosom Res. 1992;  36 751-757
  CrossrefPubMedGoogle Scholar
• 10 Talley N J, McNeil D, Hayden A, et al. Prognosis of chronic unexplained dyspepsia.  Gastroenterology. 1987;  92 1060-1066
  PubMedGoogle Scholar
• 11 Lightdale C J. Indications, contraindications, and complications of endoscopic ultrasonography.  Gastrointest Endosc. 1996;  43 S15-S19
  PubMedGoogle Scholar
• 12 Wiklund I, Glise H, Jerndal P, et al. Does endoscopy have a positive impact on quality of life in dyspepsia?.  Gastrointest Endosc. 1998;  47 449-454
  PubMedGoogle Scholar
• 13 Colin-Jones D G, Bloom B, Bodemar G, et al. Management of dyspepsia: report of a working party.  Lancet. 1988;  1 576-579
  PubMedGoogle Scholar
• 14 Talley N J, Zinsmeister A R, Schleck C D, Melton L J III. Dyspepsia and dyspepsia subgroups: a population-based study.  Gastroenterology. 1992;  102 1259-1268
  PubMedGoogle Scholar
• 15 Sahai A V, Zimmerman M, Aabakken L, et al. Prospective assessment of the ability of endoscopic ultrasound to diagnose, exclude, or establish the severity of chronic pancreatitis found by endoscopic retrograde cholangiopancreatography.  Gastrointest. Endosc1998;  48 18-25
  CrossrefPubMedGoogle Scholar
• 16 Hoffman B J, Wallace M B, Eloubeidi M A, et al. How many supervised procedures does it take to become competent in EUS? Results of a multicenter three year study [abstract].  Gastrointest Endosc. 2000;  51 AB139
  PubMedGoogle Scholar
• 17 Johannessen T, Petersen H, Kleveland P M, et al. The predictive value of history in dyspepsia.  Scand J Gastroenterol. 1990;  25 689-697
  PubMedGoogle Scholar
• 18 Thompson W G. Dyspepsia: is a trial of therapy appropriate?.  Can Med Assoc J. 1995;  153 293-299
  PubMedGoogle Scholar
• 19 Heikkinen M, Pikkarainen P, Takala J, et al. General practitioners’ approach to dyspepsia. Survey of consultation frequencies, treatment, and investigations.  Scand J Gastroenterol. 1996;  31 648-653
  PubMedGoogle Scholar
• 20 Sahai A V, Mishra G, Penman I, et al. EUS to detect evidence of pancreatic disease in patients with persistent or nonspecific dyspepsia.  Gastrointest Endosc. 2000;  52 153-159
  CrossrefPubMedGoogle Scholar
• 21 Bytzer P, Schaffalitzky de Muckadell O. Prediction of major pathologic conditions in dyspeptic patients referred for endoscopy. A prospective validation study of a scoring system.  Scand J Gastroenterol. 1992;  27 987-992
  PubMedGoogle Scholar
• 22 Edenholm M, Gustavsson R, Jansson O, et al. Endoscopic findings in patients with ulcer-like dyspepsia.  Scand J Gastroenterol. 1985;  109 Suppl 163-167
  PubMedGoogle Scholar
• 23 Heikkinen M, Pikkarainen P, Takala J, et al. Etiology of dyspepsia: four hundred unselected consecutive patients in general practice.  Scand J Gastroenterol. 1995;  30 519-523
  PubMedGoogle Scholar
• 24 Johnsen R, Bernersen B, Straume B, et al. Prevalences of endoscopic and histological findings in subjects with and without dyspepsia.  BMJ. 1991;  302 749-752
  PubMedGoogle Scholar
• 25 Kahn K L, Greenfield S. The efficacy of endoscopy in the evaluation of dyspepsia. A review of the literature and development of a sound strategy.  J Clin Gastroenterol. 1986;  8 346-358
  PubMedGoogle Scholar
• 26 Chak A, Isenberg G, Mallery S, et al. Prospective comparative evaluation of video US endoscope.  Gastrointest Endosc. 1999;  49 695-699
  PubMedGoogle Scholar

A. V. Sahai,M.D. 

Département de Gastroentérologie
CHUM, Campus St Luc

1058 Rue Saint Denis
Montréal, Québec H2X 3J4
Canada


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Email: anand.sahai@sympatico.ca