How useful is selection based on alarm symptoms in requesting gastroscopy?An evaluation of diagnostic determinants for gastro-oesophageal malignancy

Objective: To derive and evaluate diagnostic determinants of gastro-oesopha geal malignancy as a means of helping family physicians select patients for 'open-access' gastroscopy. In this multicenter study, 861 consecutive pati ents were investigated with first-time gastroscopy (study population). Anot her 1153 patients were studied during the next 6 years (validation populati on). General practitioners registered symptoms relevant to malignancy and p atient histories; the results of gastroscopies were received from the endos copists. Methods: Univariate and multivariate analyses resulted in four rel evant symptoms that were then compared with 'alarm symptoms' previously pub lished in the literature. Receiver-operating characteristic analysis was us ed to evaluate the probability of finding malignancy using these two sets o f symptoms. Results: Positive answers regarding the symptoms, weight loss a nd dysphagia, together with negative answers on pain during the night and h eartburn, predicted malignancy in the study population with an AUC (area un der the curve) of 0.90. 'Alarm symptoms' performed less well in the study p opulation (AUC 0.85), although reproducibility was better in the validation population (0.71 versus 0.63). If exclusion of malignancy had been chosen as the only valid reason for requesting gastroscopy, then pre-selection wit h the help of these symptoms would have reduced the number of requests by 1 0%. Conclusion: Thorough evaluation of 'classical' alarm symptoms in dyspep tic patients might help minimize unnecessary gastroscopy requests by GPs se eking a safe treatment decision.