The effectiveness of panendoscopy on diagnostic and therapeutic decisions about chronic abdominal pain.

To evaluate the impact of panendoscopy on diagnosis and management, we asked several gastroenterologists to state their diagnoses, management plans, and confidence in these plans before performing endoscopy in patients with chronic abdominal or thoracic pain; and to repeat the same decisions after endoscopy. To evaluate acceptance of the procedure, patients were later interviewed about their discomfort during its performance. To check the way that changes in diagnosis may have affected patient management, we formed six diagnostic groups that roughly correspond to differing treatments. The postendoscopic diagnostic groupings revealed two unsuspected cancers and disagreed with the original classification in 38 (45%) of 84 patients. Dramatic or substantial changes in management occurred in 37 (44%) patients, but often did not correspond to changes in diagnosis. Conversely, management was often unchanged despite alterations in diagnosis. Patients expressed about equal preferences for barium meal as for panendoscopy, and 75% would have agreed to a repeat endoscopy without hesitation. Although the ultimate benefits of postendoscopy management changes were not ascertained, we believe that these results support the use of panendoscopy in patients with persistent and unexplained symptoms.