From the Guidelines
Esophagogastroduodenoscopy (EGD) is indicated for patients with heartburn and alarm symptoms, such as dysphagia, bleeding, anemia, weight loss, and recurrent vomiting, as well as for 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 EGD include:
- Persistent upper abdominal symptoms despite appropriate medical therapy
- Unexplained iron deficiency anemia
- Difficulty swallowing (dysphagia) or painful swallowing (odynophagia)
- Persistent vomiting of unknown cause
- Suspected gastroesophageal reflux disease (GERD) with concerning symptoms like weight loss or anemia EGD is also indicated for surveillance of Barrett's esophagus, screening for varices in patients with cirrhosis, evaluation of gastrointestinal bleeding, and assessment of abnormal imaging findings 1. Additionally, it's used for therapeutic purposes such as removal of foreign bodies, dilation of strictures, placement of feeding tubes, treatment of bleeding lesions, and removal of polyps. The procedure allows direct visualization of the esophagus, stomach, and duodenum, enabling physicians to identify mucosal abnormalities, collect tissue samples for biopsy, and perform therapeutic interventions. EGD is generally safe but carries small risks of bleeding, perforation, adverse reactions to sedation, and infection. Patients typically need to fast for 6-8 hours before the procedure and may require temporary adjustment of certain medications like blood thinners.
The American College of Physicians recommends that upper endoscopy be performed in patients with severe erosive esophagitis after a 2-month course of proton-pump inhibitor therapy to assess healing and rule out Barrett esophagus, and in patients with a history of esophageal stricture who have recurrent symptoms of dysphagia 1. Upper endoscopy may also be indicated in men older than 50 years with chronic GERD symptoms and additional risk factors, such as nocturnal reflux symptoms, hiatal hernia, elevated body mass index, tobacco use, and intra-abdominal distribution of fat, to detect esophageal adenocarcinoma and Barrett esophagus 1.
In terms of surveillance, the American College of Physicians recommends that patients with Barrett esophagus and no dysplasia undergo surveillance examinations at intervals no more frequently than 3 to 5 years, while those with Barrett esophagus and dysplasia require more frequent intervals 1. Overall, EGD is a valuable diagnostic and therapeutic tool for patients with upper gastrointestinal symptoms and conditions, and its use should be guided by evidence-based guidelines and recommendations.
From the Research
Indications for Esophagogastroduodenoscopy (EGD)
The indications for EGD include:
- Dyspepsia unresponsive to medical therapy or associated with systemic signs 2
- Dysphagia or odynophagia 2, 3, 4, 5
- Persistent gastroesophageal reflux symptoms 2, 3, 6
- Occult gastrointestinal bleeding 2, 3, 4
- Surveillance for malignancy 2
- Abdominal pain 3, 4
- Nausea and vomiting 4
- Bright red blood per rectum 4
- Management of leak, dysphagia, or stenosis in patients with a history of foregut surgery 5
- Management of esophageal perforation 5
- Evaluation of complications of esophageal reflux 6
- Evaluation of abnormal radiological findings in the upper gastrointestinal tract 6
- Iron deficiency anemia of unknown etiology 6
Common Indications
The most common indications for EGD are: