Limited utility of endoscopy in young patients without alarm features

Objective: Current guidelines recommend using the presence of alarm features to help determine if an upper endoscopy is appropriate as an initial diagnostic tool in young adults with dyspepsia. The study aimed to assess whether young adults without alarm features had clinically significant findings on gastroscopy. Methods: This was a retrospective study on patients 18–50 years who underwent their first gastroscopy at Landspitali University Hospital 2018–2022. Data was collected on symptoms and endoscopic findings. American Society for Gastrointestinal Endocopy (ASGE) from 2015 were used to determine adequate indication for gastroscopy. The following were considered adequate indications: suspected gastrointestinal bleeding and/or iron deficiency anemia, dysphagia, persistent vomiting, unintentional weight loss, a family history of upper gastrointestinal cancer, or suspicious findings on imaging. Results: Among 748 patients, 515/748 (69%) had an adequate indication, 52% males and 233/748 (31%) without. Endoscopic findings in the group with adequate indications were: esophagitis (20%), gastric ulcers (4.1%), duodenal ulcers (4.1%), esophageal ulcers (2.1%), gastric cancer (1.0%) and esophageal cancer (0.2%). Clinically relevant findings were rare in the group without an adequate indication and only 4/233 (1.7%) had a duodenal ulcer, all due to an H.pylori infection and only 1 gastric ulcer (0.4%). No cancers were diagnosed among those without an adequate indication. Conclusions: Patients without alarm features were less frequently diagnosed with clinically significant diseases on gastroscopy compared to patients presenting with alarm features. No cancers were diagnosed in those without an adequate indication and clinically significant findings were rare in that group.