ENDOSCOPIC DISCRIMINATION OF GASTRIC-ULCERS

Because endoscopists are concerned about misidentifying a gastric neop lasm as a benign gastric ulceration (GU), routine endoscopic biopsy an d documentation of GU healing has been recommended. With the decreasin g incidence of gastric cancer in the United States, the increased use of nonsteroidal anti-inflammatory drugs, and the concern over medical care costs, this practice standard has been questioned. To study the u tility of endoscopic GU follow-up, we reviewed all cases of GU in the Duke GI-Trac database over a 7-year period. We found 1,189 patients di agnosed with GU who underwent 1,698 upper endoscopies. Of these, 130 p atients underwent serial esophagogastroduodenoscopy until GU healing w as documented. We identified 19 cases of gastric neoplasm. Endoscopic impression correlated with histology as follows: positive predictive v alue, 36%; negative predictive value, 99.3%; specificity, 90%; and sen sitivity, 84%. Two of the three cases of GU in which the endoscopist's impression was benign but histology revealed malignancy occurred in t he setting of an acute gastrointestinal bleed. We conclude that more t han 99% of the time an endoscopist's initial impression that a GU is b enign is correct. Using the Medicare reimbursement scheme, approximate ly $150,000 would be spent to detect one early gastric cancer. Our res ults further question the utility of serial endoscopic evaluation of G Us until healing.