J Neurogastroenterol Motil.  2019 Oct;25(4):544-550. 10.5056/jnm19063.

What Is Appropriate Upper Endoscopic Interval Among Dyspeptic Patients With Previously Normal Endoscopy? A Multicenter Study With Bayesian Change Point Analysis

Affiliations
  • 1Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Gyeonggi-do, Korea.
  • 2Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, University of Ulsan College of Medicine, Seoul, Korea. jung.keewook30@gmail.com
  • 3Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea. kwonjg@cu.ac.kr
  • 4Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
  • 5Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Gangwon-do, Korea.
  • 6Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Chungcheongnam-do, Korea.
  • 7Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea.
  • 8Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea.

Abstract

BACKGROUND/AIMS
Appropriate interval for performing follow-up endoscopy among dyspeptic patients without abnormal findings on previous endoscopy is unclear. We analyzed the multicenter-collected data from the Korean Society of Neurogastroenterology and Motility.
METHODS
We collected clinical data of the patients who visited the gastroenterology department and underwent 2 or more sessions of upper endoscopy during 2012-2017 at 6 university hospitals in Korea. Patients with endoscopic interval between 90 days and 760 days were included. For those with multiple endoscopic sessions, only the first 2 were analyzed. Positive outcome was defined as adenoma or cancer in the upper gastrointestinal tract. To identify the point of change and estimate the properties of the stochastic process before and after the change, we used Bayesian regression with Metropolis-Hastings algorithm.
RESULTS
There were 1595 patients. Mean age was 58.8 years (standard deviation, 12.8). Median interval of endoscopy was 437 days (standard deviation, 153). On follow-up endoscopy, there were 12 patients (0.75%) who had neoplasia (4 with gastric cancer and 8 with gastric adnoma). As with the prior hypothesis, we presumed the change point (CP) of increase in frequency of organic lesion as 360 days. After random-walk Metropolis-Hastings sampling with Markov-Chain Monte Carlo iterations of 5000, the CP was 560 days (95% credible interval, 139-724). Estimated average of frequency of dysplastic lesions increased by a factor of 4.4 after the estimated CP.
CONCLUSION
To rule out dysplastic lesions among dyspeptic patients who had previously normal endoscopy, a 2-year interval could be offered as follow-up interval for repeat upper endoscopy.

Keyword

Bayes theorem; Dyspepsia; Gastroscopy; Interval; Stomach neoplasms

MeSH Terms

Adenoma
Bayes Theorem
Dyspepsia
Endoscopy*
Follow-Up Studies
Gastroenterology
Gastroscopy
Hospitals, University
Humans
Korea
Stomach Neoplasms
Upper Gastrointestinal Tract
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