title: Different perceptions of the burden of upper GI endoscopy: an empirical study in three patient groups.
abstract: BACKGROUND
  Few studies have evaluated patients' perceived burden of cancer surveillance tests. Cancer screening and surveillance, however, require a large number of patients to undergo potentially burdensome tests with only some experiencing health gains from it. We investigated the determinants of patients' reported burden of upper gastrointestinal (GI) endoscopy by comparing data from three patient groups.
  
  
  METHODS
  A total of 476 patients were included: 180 patients under regular surveillance for Barrett esophagus (BE), a premalignant disorder; 214 patients with non-specific upper GI symptoms (NS), and 82 patients recently diagnosed with upper GI cancer (CA). We assessed pain, discomfort and overall burden experienced during endoscopy, symptoms in the week afterwards and psychological distress over time (Hospital Anxiety and Depression scale and Impact of Event Scale).
  
  
  RESULTS
  Two-thirds (66%) of patients reported discomfort and overall burden of upper GI endoscopy. Only 23% reported any pain. BE patients reported significantly less discomfort, pain and overall burden than the other patients: those with NS reported more discomfort, CA patients more pain, and both more overall burden. These differences could be statistically explained by the number of previous endoscopies and whether sedation was provided or not, but not by patient characteristics.
  
  
  CONCLUSIONS
  The perception of upper GI endoscopy varies by patient group, due to potential adaptation after multiple endoscopies and aspects of the procedure.
authors.affiliation: Department of Public Health, Erasmus MC/University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands. m.essink-bot@erasmusmc.nl
authors.forename: Marie-Louise
authors.initials: ML
authors.lastname: Essink-Bot
authors.forename: Michelle E
authors.initials: ME
authors.lastname: Kruijshaar
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: Bac
authors.forename: Pieter J
authors.initials: PJ
authors.lastname: Wismans
authors.forename: Frank
authors.initials: F
authors.lastname: ter Borg
authors.forename: Ewout W
authors.initials: EW
authors.lastname: Steyerberg
authors.forename: Peter D
authors.initials: PD
authors.lastname: Siersema
mesh_terms: D000223:Adaptation, Psychological; D001294:Attitude to Health; D001471:Barrett Esophagus / Q000175:diagnosis* / Q000473:pathology / Q000523:psychology; D036262:Empirical Research; D016099:Endoscopy, Gastrointestinal; D004935:Esophageal Diseases / Q000175:diagnosis; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000175:diagnosis / Q000473:pathology*; D010465:Perception; D011159:Population Surveillance; D011581:Psychological Tests; D011594:Psychometrics; D013315:Stress, Psychological; D011795:Surveys and Questionnaires; D041742:Upper Gastrointestinal Tract