An audit of the gastroscopy service at a tertiary hospital to determine the appropriateness of indication and yield

Kaskar, Nabeal

An audit of the gastroscopy service at a tertiary hospital to determine the appropriateness of indication and yield

Thesis / Dissertation

2026

Publisher

University of Cape Town

Department

Department of Medicine

Faculty

Faculty of Health Sciences

Abstract

Background: Oesophagogastroduodenoscopy (OGD) remains the gold standard for evaluating upper gastrointestinal (GI) symptoms, yet inappropriate referrals, especially in resource-limited settings, strain healthcare systems. In South Africa, the burden of GI disease is compounded by socioeconomic factors and high rates of infectious diseases and malignancies. Objective: To assess the demographic characteristics, clinical indications, and diagnostic yield of upper GI endoscopies performed at a tertiary hospital in Cape Town over a nine-year period. Methods: A retrospective, descriptive study was conducted using data from 10,221 adult patients who underwent OGD between January 2014 and June 2023 at Groote Schuur Hospital. Indications and endoscopic findings were analyzed using standard statistical methods. Results: The majority of patients were over 45 years (70.7%) and female (58.8%). Dyspepsia (46.9%), anaemia, and upper GI bleeding were the most common indications. Overall, 72% of OGDs revealed abnormal findings, with gastritis being most prevalent. Malignancies were uncommon, with gastric and oesophageal cancer identified in 0.9% and 0.62% of cases, respectively. Diagnostic yield was significantly higher in patients over 45 and those presenting with anaemia, vomiting, or GI bleeding. Younger patients had higher rates of normal findings and oesophageal varices. Conclusions: The study highlights the high diagnostic yield of OGD when guided by appropriate indications, particularly in older patients and those with alarm symptoms. Improved triage, guideline adherence, and preventive strategies are essential for optimizing endoscopy services in resource-constrained environments. Future research should focus on outcomes of targeted interventions, including H. pylori eradication and liver disease screening.