A closer look at same-day bidirectional endoscopy.
BACKGROUND
Same-day bidirectional endoscopy (BDE) is commonly used in clinical practice.


OBJECTIVE
Our purpose was to determine the frequency, patient demographics, indications, and significant endoscopic findings for patients undergoing BDE.


METHODS
Retrospective study with a national endoscopic database.


METHODS
Diverse clinical practice settings in the United States, including 75% from private practice.


METHODS
A total of 591,074 adult patients had upper or lower endoscopy; 66,265 patients (11.2%) with same-day BDE and a subgroup (n = 9067) with a common indication for both upper and lower examinations are the subjects of this analysis.


METHODS
Age, sex, and procedure indication were analyzed in all subjects. Significant endoscopic findings were measured in patients with a single indication of anemia, a positive fecal occult blood test (FOBT), or abdominal pain/dyspepsia (pain) for both upper and lower endoscopy.


METHODS
The Clinical Outcomes Research Initiative (CORI) national endoscopic database was analyzed to determine the number of patients who underwent same-day BDE between 2000 and 2004. Patients with a single indication of anemia, positive fecal occult blood test (FOBT), or abdominal pain/dyspepsia (pain) on both EGD and colonoscopy were included for the analysis of endoscopic findings. Significant upper GI findings were defined as suspected malignancy, arteriovenous malformation (AVM), ulcer, Barrett's esophagus, and stricture. Significant lower GI findings included suspected malignancy, polyp >9 mm, and AVM.


RESULTS
A total of 591,074 patients had upper and/or lower endoscopy; 66,265 patients (11.2%) had same-day BDE. The majority of patients were female (52.1%), and the mean age of patients with BDE was 60.8 years. A total of 6538 patients (9.9%) had anemia, 1169 (1.8%) had a positive FOBT, and 1360 (2.1%) had pain as the sole indication for both examinations. After adjustment for age and sex, significant findings were higher in patients with anemia than in those with pain (odds ratio 1.89; 95% CI, 1.59-2.26) and for patients with positive FOBT versus pain (odds ratio 1.83; 95% CI, 1.48-2.26).


CONCLUSIONS
Retrospective analysis with possible bias. Fewer patients with pain had significant findings compared to the other two groups (P value <.0001).


CONCLUSIONS
More than 10% of patients undergoing upper or lower endoscopy receive same-day BDE. BDE commonly revealed important conditions in patients with anemia or positive FOBT. Bidirectional endoscopy commonly revealed important pathology in patients with anemia or positive FOBT. Patients with pain had a lower prevalence of serious findings compared to the other groups studied. The benefits of BDE in patients with pain are uncertain and require additional investigation.
Urquhart
Jennifer
J
Oregon Health and Science University, Department of Gastroenterology, Portland, Oregon 97239, USA. urquhart@ohsu.edu
Eisen
Glenn
G
Faigel
Douglas O
DO
Mattek
Nora
N
Holub
Jennifer
J
Lieberman
David A
DA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000175:diagnosis; D003113:Colonoscopy; D016208:Databases, Factual; D016099:Endoscopy, Gastrointestinal / Q000379:methods; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009780:Occult Blood; D012189:Retrospective Studies