What are the indications for Upper Gastrointestinal (GI) Endoscopy?

From the Guidelines

Upper GI Endoscopy is indicated in patients with alarm symptoms, persistent typical GERD symptoms despite proton-pump inhibitor therapy, and severe erosive esophagitis.

Indications for Upper GI Endoscopy

• Alarm symptoms: Upper endoscopy is indicated in men and women with heartburn and alarm symptoms such as dysphagia, bleeding, anemia, weight loss, and recurrent vomiting 1.
• Persistent typical GERD symptoms: It is also indicated in men and women with typical GERD symptoms that persist despite a therapeutic trial of 4 to 8 weeks of twice-daily proton-pump inhibitor therapy 1.
• Severe erosive esophagitis: Additionally, upper endoscopy is indicated in patients with severe erosive esophagitis after a 2-month course of proton-pump inhibitor therapy to assess healing and rule out Barrett esophagus 1.
• History of esophageal stricture: Patients with a history of esophageal stricture who have recurrent symptoms of dysphagia are also candidates for upper endoscopy 1.

Optional Indications

• Chronic GERD symptoms: Upper endoscopy may be indicated in men older than 50 years with chronic GERD symptoms and additional risk factors to detect esophageal adenocarcinoma and Barrett esophagus 1.
• Surveillance evaluation: It may also be indicated for surveillance evaluation in men and women with a history of Barrett esophagus, with intervals of 3 to 5 years for those with no dysplasia and more frequent intervals for those with dysplasia 1.

From the Research

Indications for Upper Gastrointestinal (GI) Endoscopy

The indications for upper GI endoscopy include:

• Dyspepsia unresponsive to medical therapy or associated with systemic signs 2
• Dysphagia or odynophagia 2
• Persistent gastroesophageal reflux symptoms 2
• Occult gastrointestinal bleeding 2
• Surveillance for malignancy 2
• Hematemesis 3
• Suspicion for gastric or oesophageal tumours 3
• Troublesome upper GI symptoms 3

Diagnostic and Therapeutic Uses

Upper GI endoscopy is used for:

• Diagnosis of upper GI cancers 4
• Staging of upper GI cancers 4
• Screening for pre-malignant lesions 4
• Palliation in cases of advanced malignancy 4
• Therapeutic procedures such as foreign-body removal and stricture dilatation 2

Appropriateness of Indications

Studies have shown that appropriate indications for upper GI endoscopy have significantly higher rates of clinically significant findings 5

• Appropriate indications are defined as per American Society for Gastrointestinal Endoscopy criteria 5
• Use of guidelines may decrease the number of unnecessary procedures 5

Yield of Upper GI Endoscopy

The yield of upper GI endoscopy in low-risk patients with dyspepsia is very limited 6

• Major endoscopic findings were seen in 3.7% of patients 6
• Minor endoscopic findings were seen in 15.6% of patients 6
• Endoscopic findings indicative of upper GI cancer were reported in 0.3% of patients 6