Appropriateness of indications for diagnostic upper gastrointestinal endoscopy in India

Sumathi B, Navaneethan U, Jayanthi V
Correspondence: Dr Udayakumar Navaneethan, udhaykumar81@yahoo.co.in

ABSTRACT
Introduction Guidelines for an upper gastrointestinal endoscopy have been outlined for the Western population, but not yet for India. The study aimed to assess the appropriateness of upper gastrointestinal endoscopy for patients with dyspepsia and to identify the cut-off age for endoscopy from an Indian perspective.
Methods Patients referred for upper digestive endoscopy to a university clinic in India were prospectively studied between January 2004 and June 2005. Patients who presented with dyspepsia and those with isolated alarm symptoms without dyspepsia who underwent endoscopy were included. The cut-off age for the detection of upper gastrointestinal tract carcinoma in dyspepsia was derived.
Results A total of 3,432 endoscopies were performed during the study period. There were 2,068 men and 1,364 women. The overall mean age was 41.6 +/- 15 (range 7–85) years. 18.3 percent of 284 patients with malignancy were between 25 and 45 years of age. Using the receiver operator characteristic curve, the cut-off age for malignancy was between 35 and 44 years; specifically, the optimal cut-off age was 38 years for females and 43.5 years for males.
Conclusion In the south Indian population with dyspepsia, there were more normal and benign lesions at endoscopy. The optimal cut-off ages for detecting malignancy for both genders were also determined.

Keywords: dyspepsia, endoscopy, malignancy, upper gastrointestinal endoscopy
Singapore Med J 2008; 49(12): 970-976