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A Simple Pre-endoscopy Score for Predicting Risk of Malignancy in Patients with Dyspepsia: A 5-Year Prospective Study

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Abstract

Background

The guidelines for performing endoscopy in dyspeptic patients based on clinical parameters alone have shown variable performance, and there is a need for better prediction tools.

Aim

We aimed to prospectively develop and validate a simple clinical-cum-laboratory test-based scoring model to identify dyspeptic patients with high risk of upper gastrointestinal malignancy (UGIM).

Methods

Adult patients with dyspeptic symptoms were prospectively recruited over 5 years. Clinical details including alarm features were recorded, and blood tests for hemoglobin and albumin were done before endoscopy. The presence of UGIM was the primary outcome. Risk factors for UGIM were assessed, and based on the OR of significant factors, a predictive scoring model was constructed. ROC curve was plotted to identify optimal cutoff score. The model was validated using bootstrapping technique.

Results

The study included 2324 patients (41.9 ± 12.8 years; 33.4% females). UGIM was noted in 6.8% patients. The final model had following five positive predictors for UGIM—age > 40 years (OR 3.3, score 1); albumin ≤ 3.5 g% (OR 3.4, score 1); Hb ≤ 11 g% (OR 3.3, score 1); alarm features (OR 5.98, score 2); recent onset of symptoms (OR 8.7, score 3). ROC curve had an impressive AUC of 0.9 (0.88–0.93), and a score of 2 had 92.5% sensitivity in predicting UGIM. Validation by bootstrapping showed zero bias, which further strengthened our model.

Conclusion

This simple clinical-cum-laboratory test-based model performed very well in identifying dyspeptic patients at risk of UGIM. This can serve as a useful decision-making tool for referral for endoscopy.

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Funding

The study was funded by an internal Grant (FLUID Grant) from the parent institute (Christian Medical College, Vellore) (Grant No. 22X 453) where the study was done.

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Authors and Affiliations

  1. Department of Gastroenterology, Christian Medical College and Hospital, Vellore, Tamil Nadu, 632004, India

    Amit Kumar Dutta, Sudipta Dhar Chowdhury, Sajith Kattiparambil Gangadharan, Reuben Thomas Kurien, Deepu David, Ebby George Simon & Anjilivelil Joseph Joseph

  2. Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India

    Grace Rebekah

  3. Molecular Cardiology Unit, Department of Biochemistry, School of Biological Sciences, Madurai Kamaraj University, Madurai, Tamil Nadu, India

    Yuvaraj Subramani

  4. Department of Gastroenterology, IMS and SUM Hospital, Bhubaneswar, India

    Manoj Kumar Sahu

  5. Department of Gastroenterology, Yashoda Hospital, Secunderabad, India

    Viswanath Reddy Donapati

  6. Institute of Gastroenterology and Liver Diseases, The Madras Medical Mission, Chennai, India

    Ashok Chacko

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  1. Amit Kumar Dutta
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  2. Grace Rebekah
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  3. Sudipta Dhar Chowdhury
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Correspondence to Amit Kumar Dutta.

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Dutta, A.K., Rebekah, G., Chowdhury, S.D. et al. A Simple Pre-endoscopy Score for Predicting Risk of Malignancy in Patients with Dyspepsia: A 5-Year Prospective Study. Dig Dis Sci 63, 3442–3447 (2018). https://doi.org/10.1007/s10620-018-5245-7

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  • DOI: https://doi.org/10.1007/s10620-018-5245-7

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