YIELD OF ROUTINE ENDOSCOPY BEYOND THE DUODENAL BULB

The authors determined the clinical yield, endoscopic time, and patien t tolerance of routine upper endoscopy beyond the duodenal bulb. From May through October 1994, all patients undergoing routine esophagogast roduodenoscopy (EGD) were recruited for study. Each procedure was time d from start to finish by the endoscopy nurse, and, in addition, the t ime of the postbulbar examination was recorded. The endoscopy nurse as sessed the patient's comfort level when the endoscope was advanced int o the duodenal bulb and again at the postbulbar region. A total of 250 EGDs were performed. There were 152. males and 98 females, with a mea n age of 57.1 (range, 23-91) years. Indications for the procedure were as follows: gastroesophageal reflux disease symptoms 82, epigastric p ain 64, dysphagia 46, Barrett's surveillance 25, anemia 23, other rese arch study 16, and other 61. The mean time for the procedure was 11 mi n and 54 s, whereas the mean time for the postbulbar examination was 4 6.6 s. Patients tolerated endoscope insertion well both before and dur ing examination of the postbulbar duodenum. The only postbulbar findin g that affected clinical management was a postbulbar ulcer in a patien t without other ulcers who was positive for Helicobacter pylori. Altho ugh routine endoscopic examination beyond the duodenal bulb involves m inimal time and is well tolerated by patients, the yield of pathologic findings is low (3.6%) and the yield of findings that alter clinical management even lower (0.4%). In patients without prior GI surgery und ergoing routine EGD for indications other than suspected small bowel p athology or active upper GI bleeding, examination of the postbulbar du odenum can be considered an elective part of the procedure.