Burden and Predictors of Repeat Diagnostic Upper Endoscopy for Abdominal Pain, Heartburn, and Dysphagia in General Gastroenterology.

BACKGROUND

Endoscopy access is limited nationwide.

AIMS: We aimed to characterize the burden of repeated upper endoscopies for indications of abdominal pain, heartburn, and dysphagia.

METHODS

We reviewed all patients undergoing diagnostic endoscopy in a large health system between 2000 and 2023 who did not have medical conditions requiring repeat endoscopy. A Cox model was developed to predict the hazard of repeating a diagnostic endoscopy within three years as a primary outcome, represented using hazard ratios (HR) with 95% confidence intervals (CI).

RESULTS

Over a 23 year period, three-fifths of all diagnostic upper endoscopies performed were for abdominal pain (n = 5176), heartburn (n = 1535), or dysphagia (n = 3266). 90% of these procedures were ordered by gastroenterologists. The endoscopy was repeated within three years in 4.4% of patients with abdominal pain, 4.3% of patients with heartburn, and 5.6% of patients with dysphagia, usually for the same indication as the original procedure and without any intervention performed. In a multivariable model, the risk of repeating an endoscopy was either not influenced or only weakly influenced by age, sex, and mortality risk (measured using the Charlson Comorbidity Index). Findings were similar regardless of the dominant gastrointestinal symptom complaint. Gastroenterologists were no less likely to order a repeat endoscopy than primary care. Most repeat endoscopies occurred within one year of the index endoscopy.

CONCLUSION

An average gastroenterologist performs a repeat diagnostic upper endoscopy almost every day.