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. 2008 Aug;103(8):1920-5.
doi: 10.1111/j.1572-0241.2008.01945.x.

Utilization of upper endoscopy for surveillance of gastric ulcers in the United States

Sameer D Saini  1 , Glenn Eisen, Nora Mattek, Philip Schoenfeld
Affiliations

Utilization of upper endoscopy for surveillance of gastric ulcers in the United States

Sameer D Saini et al. Am J Gastroenterol. 2008 Aug.

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.

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Conflict of interest statement

CONFLICT OF INTEREST

Guarantor of the article: Sameer D. Saini, M.D., M.Sc.

Specific author contributions: Sameer D. Saini and Philip Schoenfeld were responsible for the conception and design of the study and the drafting of the manuscript. Nora Mattek performed the statistical analysis. All authors participated in the analysis and interpretation of the results and critical revision of the manuscript.

Financial support: This project was supported with the funding from NIDDK UO1 CA 89389-01 and R33-DK61778-01. In addition, the practice network (CORI) has received support from the following entities to support the infrastructure of the practice based network: AstraZeneca, Bard International, Pentax USA, ProVation, Endosoft, GIVEN Imaging, and Ethicon.

Potential competing interests: Dr. Saini has no financial conflicts of interest relevant to this study, had full access to all of the data in the study, and takes responsibility for the integrity of the data and the accuracy of the data analysis. The commercial entities had no involvement in this research.

Figures

Figure 1
Figure 1
Flowchart of selection process for inclusion in study.
Figure 2
Figure 2
Surveillance utilization (%, blue) and gastric cancer incidence (cases per 1,000, red) (SEER 17, http://seer.cancer.gov/faststats/, accessed October 25, 2007).
See this image and copyright information in PMC

Comment in

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