• Janisha Patel and Alistair McNair.
• Consultant Hepatologist and Gastroenterologist, University Hospital Southampton, Southampton.
• Eur J Gastroenterol Hepatol. 2020 Jan 1; 32 (1): 22-25.

IntroductionIn the United Kingdom, the National Institute for Health and Care Excellence 2015 guidance recommend that for suspected gastric or oesophageal cancer, general practitioners consider a non-urgent, direct-access endoscopy in patients over 55 years with only uncomplicated treatment-resistant dyspepsia. In practice, patients are referred under the urgent 2-week-wait cancer pathway.MethodsWe compared the frequency of gastric or oesophageal carcinoma in patients referred to our centre on the 2-week-wait pathway with uncomplicated dyspepsia to those who have a combination of additional alarm symptoms. The four most common indications for endoscopy referral on the 2-week-wait pathway and all combinations of those indications were examined: Dyspepsia ('ulcer-like', 'non-ulcer-like' or 'reflux-like' dyspepsia), anaemia, weight loss or dysphagia.ResultsOver 10 years, 9012 two-week-wait gastroscopies were performed, and a tumour was identified in 256 patients (2.84%). One thousand and three hundred six gastroscopies performed for uncomplicated dyspepsia and only 6 patients (0.46%) had a tumour. Therefore, uncomplicated dyspepsia alone had a poor positive predictive value of detecting gastric or oesophageal cancer. Our findings suggest dyspepsia had no significant cumulative effect on the number of patients with anaemia or weight loss found to have a lesion at endoscopy but indeed significantly decreased the likelihood of finding a tumour in those with dysphagia.ConclusionDyspepsia as a parameter to investigate gastric or oesophageal cancer contributes significantly to the growth in number of 2-week-wait referrals at a time when endoscopy units battle to meet demand. Our data show patients with uncomplicated dyspepsia rarely have gastric or oesophageal cancer and should not undergo endoscopies under the urgent 2-week-wait pathway.

9 keywords...

hide…