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GPs notch up successes after backing our manifesto

The researchers responsible for the controversial NICE dyspepsia guidance are standing by their recommendations after claiming routine endo-scopy would put patients at risk of serious injury.

Gastroenterology experts have condemned the guidance ­ which restricts endoscopy referral in the over-55s to those with alarm symptoms ­ for putting lives at risk after two audits suggested it was delaying diagnosis of cancer.

But the University of Dur-ham group commissioned by NICE to produce the guidance this week published a detailed review of current evidence and rejected the criticism as 'a secondary care perspective'.

The report, published in Alimentary Pharmacology and Therapeutics, claimed the risk of serious adverse events from upper gastrointestinal endo-scopy was one in 200 and the risk of death one in 2,000.

Professor James Mason, professor of health economics at the University of Durham and member of the guideline development group, said referring patients without alarm symptoms for endoscopy would be expensive, ineffective and dangerous.

'What is for certain is that there is a complication rate with endoscopy. This is not a risk-free practice. More widespread use of endoscopy beyond those with alarm features is costly and unlikely to benefit patients, because for the vast majority endoscopic findings do not change their treatment.'

The report concluded: 'Given the prevalence of dyspepsia, the costs of investigation, such a small yield of potentially curable cancers and the risk of harm from investigation, a policy of endoscopy in patients without alarm symptoms is not justifiable.'

NICE guidance on dyspepsia, published in August, advises that GPs should 'test and treat' over-55s with dyspepsia and only refer for endoscopy if symptoms persist.

Dr Mark Follows, a GP with a special interest in gastroenterology in Airedale, West Yorkshire, said endo-scopy was unpleasant for patients and did not increase cancer diagnoses.

'The entire basis of routine endoscopy was to find early gastric cancer but it does not do that. Having a tube the size of your little finger down your throat is not pleasant.'

Professor Mason said NICE was likely to bring the two sides of the argument together to hammer out a solution.

Arguments for and

against

For routine endoscopy in over-55s

·One in 15 patients over 55 referred with new-onset dyspepsia had cancer, one audit found

·Diagnosis delayed by three months

·Nearly half of gastric cancers may be missed

Against routine endoscopy in over-55s

·Risk of serious injury for upper GI endoscopy: one in 200; risk of death: one in 2,000

·Upper GI malignancy uncommon in patients with dyspepsia

·Cancers identified have poor prognosis

·High costs of endoscopy

By Cato Pedder

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