This article is a companion piece to the preceding article and looks at underuse of upper gastrointestinal endoscopy in the same 8,000 visits and over 600 patients who complained of upper digestive symptoms. Criteria of necessity were used to determine who should get endoscopy. Underuse was identified in 72 of the 611 patients, or about 12% of all patients with upper GI digestive symptoms who presented to a primary care setting. This article established that underuse of endoscopy exists in Switzerland and that the estimated overuse and underuse of endoscopy in this cohort were approximately equal. Improving quality of care will require reductions in both overuse and underuse of medical procedure.

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