Gastroscopy in the diagnosis of dyspepsia

Purpose of Assessment

To review the scientific evidence for using gastroscopy to diagnose dyspepsia and the current use of gastroscopy in Sweden.

Methods

Systematic review, cost analysis, cost effectiveness.

Review process for the publication

Internal review by project group, SBU Board and SBU Expert Group. Additional external review by experts in the field.

Content of Report

Symptoms of dyspepsia are responsible for about 2-4% of all ambulatory physician visits in Sweden – about 374,000 visits annually. Since 1975, the number of X-ray examinations of the stomach has decreased dramatically (from 175,000 to 52,000) and gastroscopy examinations have increased from about 20,000 to more than 100,000, with a decrease in the total number of stomach examinations for dyspepsia.

Gastroscopy is performed at all of the 93 hospitals in Sweden with departments of medicine and surgery, 6 private units and 3 community health centers. During 1987 about 106,000 examinations were performed by 907 physicians, most of whom were specialists. More than 50% of examinations were performed on referral from the primary care level.

The following issues were identified: education of endoscopists, competence levels, importance of minimizing waiting times, value of combining the examination with taking a mucous membrane specimen, and the importance of well-defined indications for gastroscopic examination.

The direct cost for a gastroscopy examination is 850 SEK, and 910 SEK for a double contrast X-ray examination of the stomach. Gastroscopy has the lowest cost per discovered morbid change.