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Endoscopy
Original research
The Edinburgh Gastric Ulcer Score (EGUS): evaluation of a risk tool for gastric ulcer follow-up
  1. Rebecca K Grant1,2,
  2. William M Brindle3,
  3. Eleanor F Watson2,
  4. Ian D Penman1,
  5. Nicholas I Church1,
  6. John N Plevris1,
  7. Benjamin M Shandro1,
  8. Aaron P McGowan1,
  9. Timothy T Gordon-Walker1,
  10. Michael J Williams1,
  11. Carol S Blair1,
  12. Colin L Noble2,
  13. Gail S M Masterton1,
  14. Rahul Kalla1
  15. on behalf of the Edinburgh GI Audit and Research (EGAR) Collaborative
  1. 1The Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, UK
  2. 2Gastrointestinal Unit, Western General Hospital, Edinburgh, UK
  3. 3Department of Gastroenterology, Victoria Hospital, Kirkcaldy, UK
  1. Correspondence to Dr Rebecca K Grant; rebecca.grant9{at}nhs.scot

Abstract

Objective In May 2021 we implemented a locally developed gastric ulcer protocol. Patients with low Edinburgh Gastric Ulcer Scores (EGUS) and benign biopsy results at index oesophagogastroduodenoscopy (OGD1) were recommended to not undergo follow-up OGD (OGD2). We aimed to validate the EGUS and identify any gastric cancer diagnoses since protocol adoption.

Design Patients diagnosed with a gastric ulcer at OGD1 in NHS Lothian from 24 May 2021 to 24 June 2023 were identified. Data regarding the EGUS and biopsy rates were gathered and compared with the protocol. Electronic patient records were reviewed for subsequent diagnoses of gastric cancer.

Results In total, 236 patients were diagnosed with a gastric ulcer; 9.7% (n=23) were diagnosed with gastric cancer at OGD1. The EGUS produced a negative predictive value of 95.7%.

OGD2s were performed in 46.0% (n=98/213) of patients; in 61.2% (n=60/98) this was in accordance with the protocol. No new pathology was identified at follow-up for OGD2s performed contrary to the protocol (median follow-up time 22 months (IQR 17–27)).

OGD2s were not performed in 54.0% (n=115/213) of patients; in 83.5% (n=96/115) this was in accordance with the protocol. At follow-up (median 22 months, IQR 17–29), there were no gastric cancer diagnoses in these patients.

Conclusion The protocol is a safe and effective method to reduce the burden of repeat OGDs. Crucially, protocol adherence has demonstrated no missed gastric cancer diagnoses. Continued monitoring of patient outcomes is essential.

  • CANCER
  • ENDOSCOPY
  • GASTRIC AND DUODENAL ULCERS

Data availability statement

Data are available upon reasonable request. Data are available upon reasonable request to the corresponding author.

https://doi.org/10.1136/flgastro-2024-102859

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    Data availability statement

    Data are available upon reasonable request. Data are available upon reasonable request to the corresponding author.

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    Footnotes

    • X @rebeccakg6, @@GastronautIan, @@john_plevris, @@rahul_kalla

    • Contributors RKG contributed to data collection, drafting the manuscript and statistical analysis. WMB and EFW contributed to data collection and revision of the manuscript. IDP, NIC, JNP, BMS, CLN, APM, TTG-W, MJW, CSB and GSMM contributed to revision of the manuscript. RK is senior author and contributed to revision of the manuscript for important intellectual content. RKG is the guarantor of the work.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.