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Curb on gastroscopy will have little impact on patient outcome

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Revised UK guidelines restricting open access gastroscopy will miss just a few cases of curable cancer in patients with uncomplicated dyspepsia, a retrospective survey of patient outcomes has confirmed.

Just five patients out of 14 (36%) with dyspepsia but no “alarm” symptoms in the four year survey had a malignant oesophageal or gastric tumour removed and were alive three to six years after the diagnosis. One patient was unfit for surgery, and the remaining patients had metastases. Three patients were aged under 55 years, only one of whom had a resection.

The survey identified 228 patients with upper gastrointestinal (GI) cancer from 11 145 gastroscopies performed during 1998–2002 in one hospital in South Wales. Most patients (214, 94%) presented with alarm signs/symptoms; 25 were aged under 55 years and two under 45. One caveat is the lack of potentially pertinent data, such as, pre-existing symptoms, Helicobacter pylori infection, and treatment with proton pump inhibitors from general practitioner records.

In 2004 the National Institute for Health and Clinical Excellence (NICE) recommended that any patients without alarm signs/symptoms should not have gastroscopy, unless they are aged over 55 with persistent symptoms of dyspepsia after H pylori treatment and acid suppression treatment.

Fear of possible cancer has driven the need for open access gastroscopy, even though the incidence of cancer in patients with no alarm symptoms is very low, about 2%. Most upper GI cancers are accompanied by alarm symptoms. Just under 10% of deaths from cancer in England and Wales are because of these cancers.