Appropriateness of Indications and Factors Associated With Abnormal Findings in Upper Gastrointestinal Endoscopy at the National Referral Hospital, Bhutan: A Cross-Sectional Study.

Introduction: Upper gastrointestinal endoscopy (UGIE) is a commonly performed procedure for evaluating complaints related to the upper gastrointestinal tract. It serves both diagnostic and therapeutic purposes. Over the last decade, there has been an increasing demand for UGIE, and selecting patients for the procedure according to standard guidelines is essential to enhance the quality of healthcare, reduce costs, and avoid unnecessary workload. This study was conducted to assess the appropriateness of indications for UGIE and the factors associated with abnormal findings in endoscopy among patients at the National Referral Hospital, Bhutan. Methods: A cross-sectional study was conducted at the Endoscopy Unit of the Surgical Department, National Referral Hospital, Bhutan. All patients aged > 12 years who underwent UGIE during the study period were included. Data were collected using a standard pro forma developed for the study, and statistical analysis was performed using SPSS software, version 23 (IBM Corp., Armonk, NY, USA). Results: A total of 200 patients underwent UGIE, of whom 50.5% (101/200) had the procedure performed for inappropriate indications. The majority of UGIE referrals originated from medical officers and residents.Among the appropriate indications, the most common was chronic liver disease with suspected portal hypertension (33.3%), followed by new-onset abdominal symptoms in patients over 50 years of age (25.3%).Abnormal endoscopic findings were detected in approximately two-thirds of cases (65.5%). The most frequently observed abnormality was esophageal varices (30.5%), followed by atrophic gastritis (26.7%) and erosive gastritis (16.0%). Esophageal and gastric growths were identified in 1.5% of cases.Notably, referrals for UGIE by medical specialists were nearly 14 times more likely to yield abnormal findings (adjusted odds ratio [aOR]: 13.5; 95% CI: 3.69-49.57; Conclusion: Approximately half of the UGIE indications were found to be inappropriate, with more than half of these cases showing normal findings on endoscopy. These results underscore the importance of adhering to standardized guidelines when recommending UGIE, to minimize unnecessary procedures, mitigate patient risks, and ensure the optimal use of healthcare resources.