P318 Validation of the Edinburgh gastric ulcer score (EGUS) to reduce routine follow-up endoscopy: a two-year single-center experience

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Background British Society of Gastroenterology guidance recommends biopsy and repeat endoscopy 6–8 weeks after diagnosis of gastric ulcer, but recent data suggest low malignancy yield. The Edinburgh Gastric Ulcer Score (EGUS)1 stratifies malignancy risk to guide follow-up. We evaluated EGUS performance in routine practice in a large district general hospital (DGH) in London. Methods Retrospective case studies of consecutive patients with endoscopic diagnosis of gastric ulcer at Whipps Cross University Hospital between January 2023 and December 2024. EGUS (range 0–6) was calculated from age, ulcer size and location when size estimation and biopsies were available. Patients with EGUS ≥3 were classified as higher risk and recommended repeat oesophagogastroscopy (OGD); those with EGUS <3 and benign appearance with adequate biopsies were considered low risk. Primary outcome was diagnosis of gastric malignancy on follow-up OGD or within 12 months. We report proportions, NPV for malignancy, and describe missing data. Results 153 patients had gastric ulcer diagnosis at their index gastroscopy. Accurate size estimation and biopsy were recorded in 52 patients (34%); which allowed accurate EGUS calculation. Follow-up OGD was performed in 28 (54%) patients. Among patients with EGUS <3 were only 23 patients (44%) All follow-up OGDs showed healed or healing mucosa, and no malignancy was diagnosed during 12-month follow-up (NPV 100%). Overall, the application of EGUS could have avoided approximately 44% of cases in this cohort. Conclusion In this single-centre audit, EGUS identified a group of low-risk ulcers with no malignancies detected during 12-month follow-up. EGUS may safely reduce unnecessary follow-up endoscopy, thereby cost savings. but larger multicenter validation and improved documentation of ulcer size/biopsy are required. Reference Grant RK, Brindle WM, Watson EF, on behalf of the Edinburgh GI Audit and Research (EGAR) Collaborative, et al. The Edinburgh gastric ulcer score (EGUS): evaluation of a risk tool for gastric ulcer follow-upFrontline. Gastroenterology 2025;16:130–13.

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