Endoscopy 2007; 39(6): 502-506
DOI: 10.1055/s-2007-966269
Original article

© Georg Thieme Verlag KG Stuttgart · New York

Is there any association between referral indications for open-access upper gastrointestinal endoscopy and endoscopic findings?

L.  A.  S.  van Kerkhoven1, 2 , S.  J.  van Rijswijck1 , L.  G.  M.  van Rossum1 , R.  J.  F.  Laheij1 , E.  M.  Witteman2 , A.  C.  I.  T.  L.  Tan2 , J.  B.  M.  J.  Jansen1
  • 1Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
  • 2Department of Gastroenterology and Hepatology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
Further Information

Publication History

submitted 7 July 2006

accepted after revision 4 December 2006

Publication Date:
19 March 2007 (online)

Background and study aim: The total number of upper gastrointestinal endoscopies is increasing, and despite guidelines for endoscopy referral for general practitioners, the proportion of patients found to have no endoscopic abnormalities is still up to 60 % (and increasing). The aim of this study was to assess the association between general practitioners’ referral indications and endoscopic findings.

Patients and methods: General practitioners of patients referred for an open-access endoscopy between January 2002 and December 2004 were asked to specify the reason for referral on a specially designed form. The relative frequency of patients actually having an endoscopic abnormality was assessed for each referral indication.

Results: A total of 1298 people were included in the study. A relevant endoscopic abnormality was found in 48 % of patients. Patients with an endoscopic abnormality were not more often referred with “alarm” symptoms or failure of empirical treatment than patients without an abnormal endoscopic finding (31 % with an endoscopic abnormality vs. 30 % without an endoscopic abnormality had alarm symptoms; 57 % of people in both groups experienced failure of empirical treatment). Referral with alarm symptoms had a positive predictive value of 4 % for cancer (prevalence 2 %; P < 0.01), and referral with reflux-like symptoms had a positive predictive value of 33 % for finding reflux esophagitis (prevalence 22 %; P < 0.01).

Conclusions: General practitioners’ referral indications for open-access endoscopy did not add any relevant predictive value for endoscopic findings in comparison with what might have been expected from overall prevalence. Only alarm symptoms slightly increased the probability of finding cancer and only reflux-like symptoms slightly increased the probability of finding reflux esophagitis.

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L. van Kerkhoven, MSc

Department of Gastroenterology

Radboud University Nijmegen Medical Center

P.O. Box 9101

6500 HB Nijmegen

The Netherlands

Fax: +31-243540103

Email: L.vanKerkhoven@MDL.umcn.nl