Objective This national analysis aimed to calculate the diagnostic yield from gastroscopy for common symptoms, guiding improved resource utilisation. Design A cross-sectional study was conducted of diagnostic gastroscopies between 1 March 2019 and 29 February 2020 using the UK National Endoscopy Database. Mixed-effect logistic regression models were used, incorporating random (endoscopist) and fixed (symptoms, age and sex) effects on two dependent variables (endoscopic cancer; Barrett’s oesophagus (BO) diagnosis). Adjusted positive predictive values (aPPVs) were calculated. Results 382 370 diagnostic gastroscopies were analysed; 30.4% were performed in patients aged <50 and 57.7% on female patients. The overall unadjusted PPV for cancer was 1.0% (males 1.7%; females 0.6%, p<0.01). Other major pathology was found in 9.1% of procedures, whereas 89.9% reported only normal findings or minor pathology (92.5% in females; 94.6% in patients <50). Highest cancer aPPVs were reached in the over 50s (1.3%), in those with dysphagia (3.0%) or weight loss plus another symptom (1.4%). Cancer aPPVs for all other symptoms were below 1%, and for those under 50, remained below 1% regardless of symptom. Overall, 73.7% of gastroscopies were carried out in patient groups where aPPV cancer was <1%. The overall unadjusted PPV for BO was 4.1% (males 6.1%; females 2.7%, p<0.01). The aPPV for BO for reflux was 5.8% and ranged from 3.2% to 4.0% for other symptoms. Conclusions Cancer yield was highest in elderly male patients, and those over 50 with dysphagia. Three-quarters of all gastroscopies were performed on patients whose cancer risk was <1%, suggesting inefficient resource utilisation. Data are available upon reasonable request. Stata Do files available upon reasonable request.

中文翻译：

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英国症状胃镜检查的诊断率：英国胃肠病学会使用国家内窥镜数据库数据进行分析


目的 这项全国性分析旨在计算胃镜检查对常见症状的诊断率，指导提高资源利用率。设计使用英国国家内窥镜数据库在2019年3月1日至2020年2月29日期间对诊断性胃镜检查进行了横断面研究。使用混合效应逻辑回归模型，纳入对两个因变量（内窥镜癌症；巴雷特食管（BO）诊断）的随机（内窥镜医生）和固定（症状、年龄和性别）影响。计算调整后的阳性预测值（aPPV）。结果 分析了 382 370 例诊断性胃镜检查； 30.4%的患者接受了年龄<50岁的患者的治疗，57.7%的患者接受了女性患者的治疗。癌症的总体未调整 PPV 为 1.0%（男性 1.7%；女性 0.6%，p<0.01）。 9.1% 的手术中发现其他主要病理，而 89.9% 报告仅正常结果或轻微病理（92.5% 为女性；94.6% 为<50 岁患者）。癌症 aPPV 最高出现在 50 多岁的人群中 (1.3%)，其中吞咽困难 (3.0%) 或体重减轻并伴有其他症状 (1.4%) 的人群。所有其他症状的癌症 aPPV 均低于 1%，对于 50 岁以下的患者，无论症状如何，均保持在 1% 以下。总体而言，73.7% 的胃镜检查是在 aPPV 癌症 <1% 的患者组中进行的。 BO 的总体未调整 PPV 为 4.1%（男性 6.1%；女性 2.7%，p<0.01）。反流 BO 的 aPPV 为 5.8%，其他症状的 aPPV 范围为 3.2% 至 4.0%。结论 老年男性患者和50岁以上有吞咽困难的患者癌症发生率最高。四分之三的胃镜检查是针对癌症风险<1%的患者进行的，这表明资源利用效率低下。数据可根据合理要求提供。 Stata Do 文件可根据合理要求提供。