0016-5107/88/3402-0118$02.00 GASTROINTESTINAL ENDOSCOPY Copyright © 1988 by the American Society for Gastrointestinal Endoscopy A prospective analysis of elective upper gastrointestinal endoscopy in the elderly C. C. Brussaard, MD M. F. J. Vandewoude, MD Edegem, Belgium The effectiveness of esophagogastroduodenoscopy in the elderly was evaluated in a prospective study of 656 consecutive patients undergoing endoscopic examination of the upper gastrointestinal tract. Forty-six percent of the patients were younger than 65 years, and 13% were in the age group above 79 years. Initial complaints and final endoscopic diagnosis were related to sex and age. Statistically significant age-related differences in outcome diagnosis were found for gastritis in younger men (p < 0.01) and negative examinations in younger women (p < 0.01). Duodenitis (p < 0.05) and duodenal ulcer disease (p < 0.05) occurred more frequently in men, whereas hiatal hernia was more frequent in women (p < 0.05). Older people presented with a more nonspecific pattern of complaints and symptoms, but, nevertheless, a good correlation was observed between complaints and endoscopic abnormalities in the elderly compared with a younger group. Since esophagogastroduodenoscopy was well tolerated and did not provoke a higher incidence of complications in the elderly, it was concluded that endoscopic evaluation of the upper gastrointestinal tract is a safe and effective examination for the investigation of upper abdominal complaints in a geriatric patient population. (Gastrointest Endosc 1988;34:118-121) In the evaluation of the upper gastrointestinal tract, esophagogastroduodenoscopy (EGD) has proved to be a safe and valuable diagnostic tool both in geriatric patients and younger adults. 1 - 6 This study was under- taken to evaluate the clinical pattern of upper gas- trointestinal symptoms and signs with aging and to correlate it with the final endoscopic findings. Fur- thermore, we wanted to know whether it is useful and efficient to perform endoscopic procedures in elderly people with nonspecific abdominal complaints. MATERIALS AND METHODS All patients admitted for EGD in the Department of General Internal Medicine and Geriatrics in our institute during a 3-year period (October 1, 1982, to October 1, 1985) were prospectively included in the EGD study. A complete EGD investigation was carried out by the same investigator (M.F.J.V.) utilizing standard criteria for technical perform- Received July 1, 1986. For revision September 29, 1986. Accepted January 29, 1987. From the Department of Internal Medicine, Division of Geriatrics, University Hospital Antwerp, Edegem, Belgium. Reprint requests: M. F. J. Vandewoude, Department of Internal Medicine, University Hospital Antwerp (UZA), Wilrijkstraat 10, B-2520 Edegem, Belgium. us ance and description of the observed lesions. Follow-up examinations within a period of 3 months after the initial EGD were excluded for evaluation. There were no exclusions because of inadequate records. The endoscopy was performed with an Olympus GIF-Q endoscope. The patients were positioned in the left lateral decubitus position after pharyngeal anesthesia with lido- caine spray. Sedation was obtained by a combined intrave- nous bolus injection of 20 mg of hyoscine N-butylbromide and 5 mg of diazepam. Age, sex, complaints, and indication for endoscopy to- gether with the observed endoscopic findings were tabulated according to rigid and well defined criteria. The endoscopic indications were (1) follow-up of a lesion noticed on a radiographic examination; (2) screening EGD on patients without specific abdominal complaints (e.g., in the work-up of staging procedures); (3) epigastric complaints: diffuse upper abdominal pain not related to eating or swallowing; (4) ulcer pain: epigastric pain with a tendency to occur at night or between meals; relief of discomfort with ingestion of food or alkali was essential to include the patient in this subgroup; (5) esophageal symptoms: in this group patients with pyrosis, substernal pain, and dysphagia were subdi- vided; (6) gastrointestinal blood loss with reference to the clinical presentation of hemorrhage; (7) examinations to follow-up the result of a previously instituted therapy were GASTROINTESTINAL ENDOSCOPY