An assessment of the potential value of endoscopic ultrasound as a cost-minimizing tool in dyspeptic patients with persistent symptoms

Study Aims: To quantify resource utilization in dyspeptic patients with per sistent symptoms and to determine whether using both the endoscopic and ult rasound capabilities of endoscopic ultrasound could reduce costs. Methods: Consecutive patients with persistent dyspepsia, after a minimum 1- month trial of acid suppression, underwent endoscopic ultrasound (EUS) and upper endoscopy using the GF-UM20 echo endoscope. Assuming EUS could replac e imaging tests which had been requested in addition to upper endoscopy, th e hypothetical costs of the EUS-based and upper endoscopy-based strategies were compared. Results: 116 patients with persistent dyspepsia underwent EUS, of whom 64.6 % had greater than or equal to 2 imaging procedures, most commonly compute d tomography (CT) (70.6 %) and abdominal ultrasound (64.7 %). The number of tests did not correlate strongly with any demographic variables. The fiber optic echo endoscope provided an adequate endoscopic and ultrasound examina tion but was damaged by retroflexion. Direct hospital costs were lowest for the EUS-based strategy. Total avoidable cost for 116 patients was $ 4137 t o $ 14 121 (or $ 36 to $ 122 per patient), depending on whether upper endos copy was performed in the non-EUS strategies. Conclusions: Patients with persistent dyspepsia may undergo multiple abdomi nal imaging procedures. Clinical variables do not predict the need for addi tional testing. An EUS-based strategy may reduce overall costs if it preven ts additional testing.