Utilization of upper endoscopy for surveillance of gastric ulcers in the United States.
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.
Saini
Sameer D
SD
Division of Gastroenterology, University of Michigan Medical School, Ann Arbor, Michigan 48109-0362, USA.
Eisen
Glenn
G
Mattek
Nora
N
Schoenfeld
Philip
P
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
Changgeng Yi Xue Za Zhi. 1992 Jun;15(2):59-63
1515972
Dig Dis Sci. 1988 Sep;33(9):1057-63
3409791
Am Surg. 1989 Feb;55(2):100-4
2916797
Eur J Gastroenterol Hepatol. 2000 Jun;12(6):635-40
10912481
Am J Gastroenterol. 2006 Apr;101(4):886-91
16635232
Am J Gastroenterol. 1997 Oct;92(10):1823-6
9382044
Am J Epidemiol. 2006 Jun 1;163(11):1025-34
16554343
Gut. 1990 Sep;31(9):989-92
2210467
Helicobacter. 2004 Jun;9(3):249-54
15165261
Gastrointest Endosc. 2008 Mar;67(3):489-96
18179793
Gastrointest Endosc. 2001 Dec;54(6):815-7
11726874
Dig Dis Sci. 1993 Feb;38(2):284-8
8425440
Gastrointest Endosc. 2004 May;59(6):664-9
15114310
Scand J Gastroenterol. 1991 Nov;26(11):1193-9
1754856
Clin Gastroenterol Hepatol. 2004 Jan;2(1):72-7
15017635
Gastroenterology. 2004 Dec;127(6):1661-9
15578502
Am J Gastroenterol. 1998 Dec;93(12):2330-8
9860388
Aliment Pharmacol Ther. 2004 Sep 1;20(5):507-15
15339322
Prev Med. 2006 Jun;42(6):460-2
16563479
Gastroenterology. 1982 Feb;82(2):228-31
7054024
Can J Gastroenterol. 1999 Jul-Aug;13(6):489-93
10464349
Gastrointest Endosc. 1986 Apr;32(2):78-80
3710103
Gastrointest Endosc. 2005 Dec;62(6):875-83
16301030