What are the indications for endoscopy (Endoscopic procedure)?

Indications for Endoscopy

Upper endoscopy is indicated in patients with alarm symptoms (dysphagia, bleeding, anemia, weight loss, recurrent vomiting), persistent GERD symptoms despite PPI therapy, and for surveillance of Barrett's esophagus. 1

Primary Indications for Upper Gastrointestinal Endoscopy

Alarm Symptoms

• Upper endoscopy is indicated in both men and women presenting with heartburn and any alarm symptoms including dysphagia, bleeding, anemia, weight loss, and recurrent vomiting 1
• Patients with progressive dysphagia require urgent endoscopic evaluation to rule out obstructive lesions 1
• Patients with hematemesis (vomiting blood) should undergo urgent endoscopy to identify and potentially treat the source of bleeding 1

Persistent Symptoms Despite Treatment

• Endoscopy is indicated in patients with typical GERD symptoms that persist despite a therapeutic trial of 4-8 weeks of twice-daily proton-pump inhibitor therapy 1
• Patients with dyspepsia who continue to have symptoms despite H2 receptor antagonist treatment should undergo endoscopic evaluation 1
• Patients with severe erosive esophagitis should have follow-up endoscopy after 2 months of PPI therapy to assess healing and rule out Barrett esophagus 1

Age-Related Indications

• Any patient over age 45 with recent onset of dyspeptic symptoms or change in dyspeptic symptoms should undergo endoscopy 1
• In men older than 50 years with chronic GERD symptoms (>5 years) and additional risk factors (nocturnal reflux, hiatal hernia, elevated BMI, tobacco use, intra-abdominal fat distribution), endoscopy may be indicated to detect esophageal adenocarcinoma and Barrett esophagus 1

Surveillance

• Patients with a history of Barrett esophagus require surveillance endoscopy, with intervals of 3-5 years for those without dysplasia and more frequent intervals for those with dysplasia 1
• Patients with a history of esophageal stricture who have recurrent symptoms of dysphagia should undergo repeat endoscopy 1

Other Specific Indications

• Patients over 60 years with anorexia, early satiety, or weight loss, even with normal barium meal results, should undergo endoscopy to rule out malignancy 1
• Patients with suspected upper GI bleeding require urgent endoscopic evaluation for both diagnostic and therapeutic purposes 2
• Patients in whom continuous long-term treatment with acid-suppressing medications is planned should have endoscopic evaluation before committing to prolonged therapy 1

Inappropriate Indications for Endoscopy

• Patients with typical symptoms of irritable bowel syndrome rather than dyspepsia 1
• Patients with mild or moderate reflux symptoms that respond to simple measures such as lifestyle changes, antacids, and alginates 1
• Patients with known duodenal ulcer who are responding well to treatment 1
• Patients who had a single episode of dyspepsia and are now asymptomatic and not receiving treatment 1
• Asymptomatic patients with sliding hiatus hernia seen on barium meal 1
• Uncomplicated heartburn responding to treatment 1
• Follow-up endoscopy after gastrectomy in patients without symptoms 1

Special Considerations

Risk Stratification

• The American Society of Anesthesiologists (ASA) classification should be used to assess patient risk before endoscopy, with higher-risk patients requiring additional precautions 3
• Patients with suspected perforation or hemodynamic instability require stabilization before endoscopy unless the procedure is part of the therapeutic plan 3

Therapeutic Applications

• Endoscopy offers therapeutic options for acute upper GI bleeding, including injection therapy, ablation, and mechanical therapy, with combination approaches being most effective 2
• For peptic ulcer disease with active bleeding or visible vessels, endoscopic therapy significantly reduces rebleeding risk, need for surgery, blood transfusions, and hospital stay 2

Complications

• Major complications of upper endoscopy include cardiopulmonary events, bleeding, and perforation, with rates increasing significantly when therapeutic interventions are performed 4
• Careful patient selection, proper preparation, and experienced endoscopists can minimize complication risks 4

Common Pitfalls and Caveats

• Failing to recognize alarm symptoms that require urgent endoscopic evaluation can lead to delayed diagnosis of serious conditions like malignancy 1
• Overuse of endoscopy in patients with functional disorders or symptoms that respond to conservative management increases healthcare costs without improving outcomes 1, 5
• Inadequate preparation or sedation can lead to incomplete examinations and missed diagnoses 3
• Endoscopy should not replace a thorough clinical evaluation but should complement it to guide appropriate management 6
• The timing of endoscopy is critical in acute bleeding scenarios, with early intervention (within 24 hours) associated with better outcomes 2