Predictors of Clinically Significant Findings and Diagnostic Yield in Upper and Lower Gastrointestinal Endoscopy: A Tertiary-Center Study

Abstract

Background: Endoscopy has become a cornerstone of gastrointestinal (GIT) diagnosis and therapy, but there is limited evidence on the patterns of endoscopic practice and outcome predictors in Iraqi patients. Objectives: To describe GIT endoscopic indications and findings in Iraqi adults, determine independent predictors of clinically significant findings in both esophagogastroduodenoscopy (OGD) and colonoscopy, and compare the results of the diagnostic procedures and indications. Methods: This was a retrospective cross-sectional study involving 705 adults who had an endoscopy at Baghdad Teaching Hospital (January 2019 to January 2022). The diagnostic yield was computed by procedure and indication. Reporting was done as per the STROBE guidelines. Results: OGD accounted for 572 procedures (81.1%); epigastric pain/dyspepsia was the leading indication (43.2%), and gastritis was the most frequent finding (47.3%). The most frequently requested indication for colonoscopy (n=133) was bleeding per rectum 75(56.3%), and 37% were normal. On logistic regression, independent predictors of significant OGD findings were age ≥50 years (p=0.004), male sex (p=0.043), and hematemesis (p=0.006). For colonoscopy, age ≥50 years (p=0.031) and IBD evaluation (p=0.043) were independent predictors. The diagnostic yield was significantly higher in OGD (p=0.001). Conclusions: Endoscopy of the upper gastrointestinal tract has a higher diagnostic yield than colonoscopy, which reflects a selected disease burden. Age predicts findings; male sex, hematemesis, and inflammatory bowel disease improve yield, supporting risk-based referral and triage.