Dual-focus Magnification, High-Definition Endoscopy Improves Pathology Detection in Direct-to-Test Diagnostic Upper Gastrointestinal Endoscopy.
BACKGROUND
In the UK, the majority of diagnostic upper gastrointestinal (UGI) endoscopies are a result of direct-to-test referral from the primary care physician. The diagnostic yield of these tests is relatively low, and the burden high on endoscopy services. Dual-focus magnification, high-definition endoscopy is expected to improve detection and classification of UGI mucosal lesions and also help minimize biopsies by allowing better targeting.


METHODS
This is a retrospective study of patients attending for direct-to-test UGI endoscopy from January 2015 to June 2015. The primary outcome of interest was the identification of significant pathology. Detection of significant pathology was modelled using logistic regression.


RESULTS
500 procedures were included. The mean age of patients was 61.5 (±15.6) years; 60.8% of patients were female. Ninety-four gastroscopies were performed using dual-focus magnification high-definition endoscopy. Increasing age, male gender, type of endoscope, and type of operator were all identified as significant factors influencing the odds of detecting significant mucosal pathology. Use of dual-focus magnification, high-definition endoscopy was associated with an odds ratio of 1.87 (95%CI 1.11-3.12) favouring the detection of significant pathology. Subsequent analysis suggested that the increased detection of pathology during dual-focus magnification, high-definition endoscopy also influenced patient follow-up and led to a 3.0 fold (p=0.04) increase in the proportion of patients entered into an UGI endoscopic surveillance program.


CONCLUSIONS
Dual-focus magnification, high-definition endoscopy improved the diagnostic yield for significant mucosal pathology in patients referred for direct-to-test endoscopy. If this finding is recapitulated elsewhere it will have substantial impact on the provision of UGI endoscopic services.
Department of Gastroenterology, Royal Liverpool and Broadgreen University Hospital Trust;Clinical Cancer Trials Unit, University of Liverpool,Liverpool, UK.
Ashley
A
Bond
Department of Gastroenterology, Royal Liverpool and Broadgreen University Hospital Trust;Clinical Cancer Trials Unit, University of Liverpool,Liverpool, UK.
Michael D
MD
Burkitt
Department of Cellular and Unit of Gastroenterology Research Molecular Physiology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK.
Trevor
T
Cox
Department of Gastroenterology, Royal Liverpool and Broadgreen University Hospital Trust, Liverpool, UK.
Howard L
HL
Smart
Department of Gastroenterology, Royal Liverpool and Broadgreen University Hospital Trust;Clinical Cancer Trials Unit, University of Liverpool,Liverpool, UK.
Chris
C
Probert
Department of Gastroenterology, Royal Liverpool and Broadgreen University Hospital Trust, Liverpool, UK.
Neil
N
Haslam
Department of Gastroenterology, Royal Liverpool and Broadgreen University Hospital Trust, Liverpool, UK. sanchoy@aol.com.
Sanchoy
S
Sarkar
D000328:Adult; D000368:Aged; D016099:Endoscopy, Gastrointestinal / Q000295:instrumentation / Q000379:methods*; D004739:England; D004935:Esophageal Diseases / Q000175:diagnosis; D005260:Female; D005767:Gastrointestinal Diseases / Q000175:diagnosis*; D020699:Gastroscopes; D006784:Hospitals, Teaching / Q000458:organization & administration; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000458:organization & administration; D012017:Referral and Consultation / Q000458:organization & administration*; D012189:Retrospective Studies; D013272:Stomach Diseases / Q000175:diagnosis