Is endoscopic screening before major surgical procedures warranted?

BackgroundGastroenterologists are frequently requested to perform endoscopic procedures to rule out cancer or other serious GI disease before major surgical operations.ObjectiveTo assess whether such requests are warranted.DesignCost benefit analysis by using decision tree and threshold analysis.PatientsSubjects scheduled for liver and kidney transplant or other major surgeries.Main Outcome MeasurementsCosts of medical and surgical procedures. The threshold value is defined as the a priori probability for a GI diagnosis, where the benefit of endoscopy changes from unfavorable to favorable as the diagnostic probability increases.ResultsFor all types of organ transplants, the threshold probability for diagnosing a GI disease by endoscopy is lower than 1%. Such a low threshold suggests that if a disease cannot be ruled out with certainty before transplant operations or any other major surgical operation, endoscopic screening would be warranted. For lesser interventions, such as percutaneous transluminal coronary angioplasty and coronary bypass grafting, the threshold value varies between 3.2% and 6.5%, which suggests that endoscopic screening may be justified if there are sufficient grounds to suspect a comorbid medical condition that could compromise the success of the planned surgical intervention.LimitationsThe model only considers procedure costs and assumes no endoscopic complications.ConclusionsEndoscopic screening before costly and invasive surgical or other medical interventions is justified.