The Edinburgh Gastric Ulcer Score (EGUS): evaluation of a risk tool for gastric ulcer follow-up

Objective In May 2021 we implemented a locally developed gastric ulcer protocol. Patients with low Edinburgh Gastric Ulcer Scores (EGUS) and benign biopsy results at index oesophagogastroduodenoscopy (OGD1) were recommended to not undergo follow-up OGD (OGD2). We aimed to validate the EGUS and identify any gastric cancer diagnoses since protocol adoption. Design Patients diagnosed with a gastric ulcer at OGD1 in NHS Lothian from 24 May 2021 to 24 June 2023 were identified. Data regarding the EGUS and biopsy rates were gathered and compared with the protocol. Electronic patient records were reviewed for subsequent diagnoses of gastric cancer. Results In total, 236 patients were diagnosed with a gastric ulcer; 9.7% (n=23) were diagnosed with gastric cancer at OGD1. The EGUS produced a negative predictive value of 95.7%. OGD2s were performed in 46.0% (n=98/213) of patients; in 61.2% (n=60/98) this was in accordance with the protocol. No new pathology was identified at follow-up for OGD2s performed contrary to the protocol (median follow-up time 22 months (IQR 17–27)). OGD2s were not performed in 54.0% (n=115/213) of patients; in 83.5% (n=96/115) this was in accordance with the protocol. At follow-up (median 22 months, IQR 17–29), there were no gastric cancer diagnoses in these patients. Conclusion The protocol is a safe and effective method to reduce the burden of repeat OGDs. Crucially, protocol adherence has demonstrated no missed gastric cancer diagnoses. Continued monitoring of patient outcomes is essential.