[Cost-benefit of upper digestive endoscopy. Frequency of early gastric cancer and negative endoscopy in relation to indications].

The increasing demand for upper gastrointestinal endoscopies (184% from 1974 to 1985) led to a review of cases in an attempt to improve the cost-benefit ratio of this diagnostic procedure (E.G.C.). Two parameters were evaluated: the frequency of early gastric cancers and, on the other hand, the incidence of negative endoscopic findings with respect to indications. The increase in the number of endoscopies performed was not matched by an increased frequency of E.G.C. diagnosed: 8.9% in 1974-1979 and 7.5% in 1980-1985 with an E.G.C./endoscopy ratio of 1:218 and 1:415 respectively; in the second period the diagnostic accuracy of endoscopy was enhanced from 42.8% to 100%. The overall frequency of negative endoscopic findings on 500 patients undergoing endoscopy in 1985, was 40.4%. The greatest number of negative findings was observed in patients with non-ulcerous dyspepsia under 50 years of age and in those with ulcerous dyspepsia with prior duodenal ulcer; on the other hand, a significant prevalence of cancerous and precancerous lesions was observed in patients over 50 with non-ulcerous dyspepsia. The results of this study suggest that patients over 50 years with non-ulcerous dyspepsia should receive early endoscopic investigation, in those under 50 an initial therapeutic approach appears reasonable. In the patients with prior duodenal ulcer endoscopy is of limited value for the assessment of response to therapy.