[Analysis of the clinical benefits and cost-effectiveness of performing a systematic second-look gastroscopy in benign gastric ulcer].
BACKGROUND
We analyzed the need to routinely perform a second gastroscopy after an initial diagnosis of benign gastric ulcer.


METHODS
A total of 226 consecutive cases of gastric ulcer were reviewed. Sensitivity (S), specificity (Sp), positive and negative predictive value (PPV and NPV) and the accuracy of the initial gastroscopy plus biopsy were analyzed, both overall and according to the initial endoscopist's experience (attending or resident physician). The diagnostic accuracy of the initial and second-look gastroscopies was compared. The number of second endoscopies required to diagnose a new case of malignant gastric ulcer and their cost was calculated, both overall and according to the endoscopist's experience.


RESULTS
There were 178 benign ulcers (79%) and 48 malignant ulcers (21%). The initial gastroscopy (S: 87.2%; Sp: 100%; PPV: 100%; PNV: 96.7%; accuracy: 96.7%) was performed by an attending physician in 74% of the patients and by a resident physician in the remaining 26%. Diagnostic accuracy was higher for attending physicians than for residents (98.2% vs. 94.8%; p=0.18). The accuracy of second-look endoscopy was 100%, with a significant improvement when compared with the initial procedure (p=0.035). Three new cases of MALT lymphoma and three new cases of gastric adenocarcinoma were diagnosed and could be treated with curative intent. The number of second gastroscopies required to diagnose a new case of malignant gastric ulcer and their economic cost was: 37.3 (4,675 Euros) for the whole group, 55.2 (6,845 Euros) for attending physicians and 19.3 (2,393 Euros) for residents.


CONCLUSIONS
Initial gastroscopy showed high diagnostic accuracy, which was slightly lower when performed by resident physicians. Second-look gastroscopy significantly improved the results, confirming the clinical benefit of this procedure in diagnosing potentially curable malignant lesions. The mean cost of each new diagnosis of malignancy was 4,675 Euros, which was three times lower if the initial gastroscopy was performed by a less experienced endoscopist.
Amorena Muro
Edurne
E
Servicio de Aparato Digestivo, Hospital de Navarra, Pamplona, España.
Borda Celaya
Fernando
F
Martínez-Peñuela Virseda
José María
JM
Borobio Aguilar
Erika
E
Oquiñena Legaz
Susana
S
Jiménez Pérez
Francisco Javier
FJ
D000230:Adenocarcinoma / Q000175:diagnosis / Q000191:economics / Q000473:pathology; D003362:Cost-Benefit Analysis; D003937:Diagnosis, Differential; D042241:Early Diagnosis; D005753:Gastric Mucosa / Q000473:pathology; D005773:Gastroscopy / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007396:Internship and Residency; D018442:Lymphoma, B-Cell, Marginal Zone / Q000175:diagnosis / Q000191:economics / Q000473:pathology; D008228:Lymphoma, Non-Hodgkin / Q000175:diagnosis / Q000191:economics / Q000473:pathology; D008505:Medical Staff, Hospital; D011230:Precancerous Conditions / Q000175:diagnosis / Q000191:economics / Q000473:pathology; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000191:economics / Q000473:pathology; D013276:Stomach Ulcer / Q000175:diagnosis* / Q000191:economics / Q000473:pathology