Current guidelines recommend that all gastric ulcers be biopsied extensively to exclude underlying malignancy.
However, many gastroenterologists opt to also perform surveillance endoscopy to document ulcer healing.
Dr Sameer Saini and colleagues from Michigan, USA examined frequency of utilization of surveillance endoscopy in patients found to have gastric ulcers using a national endoscopic database.
|Surveillance rates varied from 16% to 36% across the United States|
|American Journal of Gastroenterology|
The team used the Clinical Outcomes Research Initiative database to identify ambulatory patients diagnosed with a gastric ulcer between 2001 and 2005.
A surveillance endoscopy was defined as any endoscopy performed 3 months after index endoscopy.
The team stratified the results by patient demographic factors, index ulcer size and location, practice setting, and geographic region.
Multivariate logistic regression was performed to identify independent predictors of surveillance endoscopy utilization.
The researchers identified 6113 patients that met the inclusion/exclusion criteria, of which 1510 underwent surveillance endoscopy.
Older patients were more likely to undergo surveillance than younger patients.
However, the team noted that 15% of patients under 40 years of age underwent a surveillance examination.
Index ulcer size of 1 cm, and care in a Veterans Affairs setting were also independent predictors of surveillance endoscopy utilization.
The research team noted significant geographic variation, with surveillance rates varying from 16% to 36% across the United States.
Dr Saini's team commented, "In contrast to guideline recommendations, approximately 25% of ambulatory patients diagnosed with gastric ulcers underwent surveillance endoscopy within 3 months."
"Notably, patients at low-risk for gastric cancer, including young patients, those with small index ulcers, and those with antral ulcers, underwent surveillance at higher than expected rates."
"This suggests overuse of surveillance endoscopy."