Nomogram predicting macroscopic finding with limited or no clinical implication in 19175 patients referred to esophagogastroduodenoscopy

Abstract

Objective: The diagnostic yield of esophagogastroduodenoscopy (EGD) depends on appropriate patient selection. The aim of the current study was to create a nomogram predicting findings with limited or no clinical implication in patients referred to EGD. Patients and methods: Indications and findings were registered prospectively in patients who underwent first-time EGD from 1994 to 2013. All findings were classified as “finding with limited or no clinical implication” or “finding with or possibly with clinical implication,” and used to create a predicting nomogram. Results: A total of 19175 patients were included (female: 59.0% [n = 11,312], male: 41.0% [n = 7,863]) with 30821 combinations of indications and findings, of which 20,512 (66.6%) constituted findings with limited or no clinical implication. The median age was 61 (58.9 ± 20.6 [mean ± standard deviation]) years and age was the strongest factor associated with normal EGD. Risk relationships were determined for age and indications by sex and used to create a nomogram. Receiver operating characteristics analysis was used to validate the nomogram-calculated probability of a finding with limited or no clinical implication (area under curve: 0.721; p < 0.001). Conclusion: The present nomogram may clarify the EGD yield challenges to referring physicians and patients. Early use of the nomogram may prevent unnecessary EDGs and assist to increase the diagnostic yield of the procedure.

Keywords

• nomogram
• esophagogastroduodenoscopy
• normal
• negative
• yield