From the Guidelines
Endoscopy is indicated in patients with gastroesophageal reflux disease (GERD) who have alarm symptoms, such as dysphagia, bleeding, anemia, weight loss, and recurrent vomiting, as well as those with typical GERD symptoms that persist despite a therapeutic trial of 4 to 8 weeks of twice-daily proton-pump inhibitor therapy. The primary indications for endoscopy include:
- Persistent upper abdominal symptoms despite medication trials
- Unexplained gastrointestinal bleeding
- Iron deficiency anemia
- Unexplained weight loss
- Persistent vomiting
- Difficulty swallowing (dysphagia)
- Odynophagia (painful swallowing) It's also recommended for surveillance of Barrett's esophagus, screening for esophageal varices in cirrhosis patients, and evaluation of abnormal imaging findings 1. Therapeutic endoscopy is indicated for removal of foreign bodies, dilation of strictures, placement of feeding tubes, treatment of bleeding lesions using techniques like epinephrine injection or thermal coagulation, and polypectomy. For lower GI symptoms, colonoscopy is preferred, but upper endoscopy may be warranted if symptoms persist despite normal colonoscopy findings. Endoscopy should be performed after appropriate preparation, including fasting for at least 6-8 hours before the procedure and temporary discontinuation of anticoagulants when appropriate. The procedure allows direct visualization of the mucosa and enables tissue sampling for histopathological examination, which is crucial for diagnosing conditions like celiac disease, H. pylori infection, and malignancies that might not be evident through other diagnostic methods.
From the Research
Indications for Endoscopy
- Dyspepsia unresponsive to medical therapy or associated with systemic signs 2
- Dysphagia or odynophagia 2, 3, 4
- Persistent gastroesophageal reflux symptoms 2, 3
- Occult gastrointestinal bleeding 2
- Surveillance for malignancy 2
- Upper gastrointestinal bleeding, including peptic ulcer bleeding, gastritis, esophagitis, variceal bleeding, Mallory-Weiss syndrome, and cancer 5
- Esophageal dysphagia, including structural and motility disorders 4
- Alarm symptoms such as significant weight loss, gastrointestinal bleeding, or anorexia 3
- Lack or partial response to proton pump inhibitor treatment 3
- Prior endoscopic or surgical anti-reflux interventions 3
Specific Conditions
- Gastroesophageal reflux disease (GERD) 3
- Upper gastrointestinal bleeding 5
- Esophageal dysphagia 4
- Peptic ulcer bleeding 5
- Gastritis 5
- Esophagitis 5
- Variceal bleeding 5
- Mallory-Weiss syndrome 5
- Cancer 2, 5