Audit on Endoscopic Follow-Up of Gastric Ulcer: Compliance with the Uk, Nice Guidelines
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Saengkrajang G.
Hoque, S.
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2025
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Introduction: Peptic ulcers are a common gastrointestinal condition with potential risks for recurrence and complications. Timely follow-up, particularly repeat endoscopy, is critical for confirming ulcer healing and minimizing unnecessary interventions or missing gastric cancer. The National Institute for Health and Care Excellence (NICE) recommends repeat esophagogastroduodenoscopy (OGD) 6-8 weeks following gastric ulcer diagnosis to confirm healing. Aims and Methods: Aim: To evaluate compliance with NICE guidelines for repeat endoscopy following a gastric ulcer diagnosis within a large UK hospital trust. Method(s): A retrospective audit was conducted on patients diagnosed with gastric ulcers from October 2022 to September 2024 at Barts Health NHS Trust. Patient records, endoscopy reports, and laboratory results were reviewed to assess whether follow-up endoscopy occurred and its timing relative to NICE recommendations. Result(s): A total of 62 cases were identified and their follow up were recorded. Out of 62 patients (mean age 58 years), 53 (85%) underwent follow- up, while 9 (15%) did not. Only 12% received follow-up within the 6-8-weeks guideline window, while 50% had follow-up within 9 weeks. Most follow-ups (70%) occurred within 24 weeks. A Kaplan-Meier survival analysis (figure 1) was performed to visualise time-to-follow-up, showing a gradual increase in follow-up rates over time, with a plateau reached by 24 weeks. This analysis highlighted delays in achieving the recommended 6-8-week benchmark and demonstrated that only a minority of patients received follow-up in a timely manner. Follow-up timing influenced diagnostic outcomes. Patients reviewed before 6 weeks had a higher rate of ongoing ulcers (44%), often prompting further investigations (figure 2). Those seen between 6-8 weeks had complete ulcer healing. Among patients reviewed at 8-12 weeks and beyond 12 weeks, 27% still had ongoing ulcers, though the majority had healed. Notably, patients with follow-up beyond 12 weeks often underwent repeated endoscopy for continued management. Non-compliance was primarily due to failure to request follow-up (56%), patient non-attendance (33%), and medical inappropriateness (11%). Conclusion(s): Although most patients received follow-up endoscopy, adherence to NICE-recommended timing was suboptimal. Our study shows that while most patients were eventually followed up, only a small proOesophageal, portion were reviewed within the ideal 6-8-week window. Patients who had early follow-up (<6 weeks) often still had ongoing ulcers, necessitating unnecessary investigations due to insufficient healing time. Conversely, patients with follow-up after 12 weeks typically required repeated endoscopy for ongoing management. To optimise care, systems should be improved to ensure timely and targeted follow up. Further research should explore only targeted cases merit follow ups and patient-level factors contributing to delayed follow-up adherence. Figure 1: Kaplan-Meier Survival Curve for Follow-Up Endoscopy After Peptic Ulcer Diagnosis. The curve illustrates the cumulative proportion of patients without follow- up endoscopy over time since initial peptic ulcer diagnosis. A steep initial decline indicates that most follow-ups occurred within the first 24 weeks. However, only a small proportion of patients received follow-up within the NICE-recommended 6-8 week timeframe. The plateau after 24 weeks reflects the reduced likelihood of follow-up beyond this point. Figure 2: Outcomes of Follow-Up Endoscopy After Peptic Ulcer Diagnosis by Timing Interval.
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United.Eur.Gastroenterol.J.