title: Utilization of upper endoscopy for surveillance of gastric ulcers in the United States.
abstract: BACKGROUND
  Current guidelines recommend that all gastric ulcers (GUs) be biopsied extensively to exclude underlying malignancy. However, many gastroenterologists opt to also perform surveillance endoscopy (EGD) to document ulcer healing. The purpose of this study was to examine frequency of utilization of surveillance EGD in patients found to have GUs using a national endoscopic database.
  
  
  METHODS
  The Clinical Outcomes Research Initiative (CORI) database was used to identify ambulatory patients diagnosed with a GU between 2001 and 2005. A surveillance EGD was defined as any EGD performed < or =3 months after index EGD. Results were stratified by patient demographic factors, index ulcer size and location, practice setting, and geographic region. Multivariate logistic regression was performed to identify independent predictors of surveillance EGD utilization.
  
  
  RESULTS
  In the database, 6,113 patients met our inclusion/exclusion criteria, of which 1,510 (24.7%) underwent surveillance EGD. Older patients were more likely to undergo surveillance than younger patients (P < 0.0001), though a substantial minority (15.2%) of patients <40 years of age underwent a surveillance examination. Index ulcer size > or =1 cm and care in a Veterans Affairs (VA) setting were also independent predictors of surveillance EGD utilization. Significant geographic variation was noted, with surveillance rates varying from 16.0% to 35.9% across the United States (P < 0.0001).
  
  
  CONCLUSIONS
  In contrast to guideline recommendations, approximately 25% of ambulatory patients diagnosed with GUs underwent surveillance EGD within 3 months. Notably, patients at low-risk for gastric cancer, including young patients, those with small index ulcers, and those with antral ulcers, underwent surveillance at higher than expected rates, which suggests overuse of surveillance EGD.
authors.affiliation: Division of Gastroenterology, University of Michigan Medical School, Ann Arbor, Michigan 48109-0362, USA.
authors.forename: Sameer D
authors.initials: SD
authors.lastname: Saini
authors.forename: Glenn
authors.initials: G
authors.lastname: Eisen
authors.forename: Nora
authors.initials: N
authors.lastname: Mattek
authors.forename: Philip
authors.initials: P
authors.lastname: Schoenfeld
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D016208:Databases, Factual; D016145:Endoscopy, Digestive System / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D013276:Stomach Ulcer / Q000453:epidemiology / Q000473:pathology* / Q000628:therapy; D013997:Time Factors; D014481:United States / Q000453:epidemiology
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