Primary care dyspeptic patients without alarm symptoms rarely have serious underlying conditions at endoscopy. The costs associated with diagnosing an occult malignancy are large, but an age cut-off of 50 years for early endoscopy provides the best assurance that an occult malignancy will not be missed.
Vakil, N., Talley, N., van Zanten, S. V., Flook, N., Persson, T., Björck, E., Lind, T., & Bolling-Sternevald, E. (2009). Cost of detecting malignant lesions by endoscopy in 2741 primary care dyspeptic patients without alarm symptoms. Clinical Gastroenterology and Hepatology, 7(7), 756-761. https://doi.org/10.1016/j.cgh.2009.03.031 (Original work published 2009)