From the Guidelines
An inappropriate indication for upper gastrointestinal endoscopy is asymptomatic patients with a history of esophageal stricture [ 1 ]. According to the American College of Physicians (ACP), upper endoscopy is not indicated in asymptomatic patients with a history of esophageal stricture, but is appropriate in patients with recurrent symptoms of dysphagia [ 1 ]. Additionally, screening upper endoscopy should not be routinely done in women of any age or in men younger than 50 years regardless of GERD symptoms, because the incidence of cancer is very low in these populations [ 1 ].
Some key points to consider when evaluating the need for upper endoscopy include:
- Alarm symptoms: Upper endoscopy is indicated in patients with heartburn and alarm symptoms, such as dysphagia, bleeding, anemia, weight loss, and recurrent vomiting [ 1 ].
- Empirical PPI therapy: Upper endoscopy is not an appropriate first step in most patients with GERD symptoms and is indicated only when empirical PPI therapy for 4 to 8 weeks is unsuccessful [ 1 ].
- Risk factors for Barrett esophagus: Screening endoscopy may be indicated in men older than 50 years with several risk factors for Barrett esophagus, including chronic GERD symptoms, nocturnal reflux symptoms, hiatal hernia, elevated body mass index, tobacco use, and intra-abdominal distribution of fat [ 1 ].
- Surveillance intervals: In men and women with Barrett esophagus and no dysplasia, surveillance examinations should occur at intervals no more frequently than 3 to 5 years [ 1 ].
It is essential to weigh the benefits of upper endoscopy against the potential harms and to follow society guidelines for upper endoscopy indications to optimize resource utilization and minimize unnecessary procedures [ 1 ].
From the Research
Inappropriate Indications for Upper Gastrointestinal Endoscopy
- Isolated dyspepsia without adequate proton-pump inhibitor (PPI) therapy is considered an inappropriate indication for upper gastrointestinal endoscopy, as stated in the study 2.
- The American Society for Gastrointestinal Endoscopy (ASGE) guidelines suggest that patients with dyspepsia should first be treated with PPI therapy before undergoing endoscopy, unless they have alarm symptoms or are at high risk of malignancy 2, 3.
- The study 4 found that the yield of upper GI endoscopy in patients below 60 years and without alarm symptoms presenting with dyspepsia is very limited, suggesting that endoscopy may not be necessary in these cases.
- The guidelines from the American College of Gastroenterology (ACG) and the Canadian Association of Gastroenterology (CAG) also recommend a non-invasive test for Helicobacter pylori and treatment if positive, before considering endoscopy in patients under 60 years old with dyspepsia 5.