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Too Many Repeat Upper Endoscopies?

Summary and Comment |
February 27, 2014

Too Many Repeat Upper Endoscopies?

  1. David J. Bjorkman, MD, MSPH (HSA), SM (Epid.)

One third of patients who underwent upper endoscopy had repeat exams within 3 years, half of which were not indicated.

  1. David J. Bjorkman, MD, MSPH (HSA), SM (Epid.)

Database analyses have suggested that established guidelines for the use of endoscopy are often not followed. To examine the use of repeat upper endoscopy (esophagogastroduodenoscopy), investigators reviewed a 5% sample of Medicare beneficiaries between 2004 and 2006. The researchers developed their own criteria for diagnoses that would warrant a repeat endoscopy and then determined the frequency of repeat procedures and the indications for them.

Of the 12% of patients who had at least one endoscopy, 33% underwent a repeat exam within 3 years. Of patients who underwent a repeat procedure, 54% did not have an index diagnosis that warranted it. When new clinical events were excluded, 43% of patients who underwent a second exam did not have a diagnosis that justified it.

Comment

This study showed that one third of Medicare beneficiaries who underwent esophagogastroduodenoscopy had a repeat examination within 3 years and that nearly half of these procedures were not indicated. However, it also showed that of patients for whom a repeat exam was indicated (e.g., for Barrett esophagus surveillance), only 50% actually underwent the procedure. Thus, the study indicates a similar magnitude of underuse as overuse. The study had multiple methodological problems. The authors state a bias that endoscopy is generally overused but acknowledge that the study could not address this issue. The information on indications and diagnoses could not be verified. The need for an additional exam because of progressive symptoms (such as dysphagia) was not acknowledged. There was also no way to determine if the provider was the same for the two procedures — which is important since patients often switch providers, and records are commonly not available to the new provider. Both overuse and underuse of repeated endoscopy can result from this lack of continuity of care.

  • Disclosures for David J. Bjorkman, MD, MSPH (HSA), SM (Epid.) at time of publication Leadership positions in professional societies World Gastroenterology Organization (Treasurer)

Citation(s):

Reader Comments (1)

dypmc Pune Physician, Gastroenterology, medical college hospital, India

I agree with the comments about overuse and unnecessary request for UGI scopy since most of the hospitals have free open access without screening of patients by gastroenterologist for risk benefit aspect in diagnosis

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