UK researchers extracted data from the Hospital Episode Statistics database, which stores information on all patients admitted to NHS hospitals in England. All elective gastroscopy episodes were summed for people aged over 16 years in 2006/2007 and 2007/2008 and these data was then mapped to their GPs. Practices were then ranked according to their adjusted annual gastroscopy rate and then divided into low, medium and high tertiles.
Patients belonging to practices in the lowest gastroscopy tertile were 73% more likely to be admitted as an emergency – where their gastroscopy was performed unplanned – compared to patients in the highest tertile. These patients were also 14% more likely to die after 12 months and 13% less likely to undergo surgical intervention for oesophagogastric cancer, compared with the highest tertile.
What does it mean for GPs?
The authors concluded that while variation in thresholds for gastroscopy referral is expected given the controversy regarding this investigation, the data ‘provide strong evidence for an independent association between oesophagogastric cancer outcomes and gastroscopy rates at the local practice level.’ They added: ‘These findings suggest that initiatives or current guidelines aimed at limiting the use of gastroscopy may adversely affect cancer outcomes.’
Dr Michael Cohen, GPSI in gastroenterology and committee member for the Primary Care Society for Gastroenterology: ‘I have picked up a few early gastric and oesophageal cancers in patients who have been referrred with non-alarm symptoms – GPs will refer patients with alarm symptoms for gastroscopy but this usually signifies advanced disease. Current guidelines encourage referring patients for gastroscopy sensibly because endoscopy capacity in the UK is full to bursting. I do not think GPs will refer more patients for gastroscopy unless we can find some markers which may indicate early upper gastrointestinal cancer.’