1. EGD is generally indicated for evaluating: |
A. Upper abdominal symptoms, which persist despite an appropriate trial of therapy |
B. Upper abdominal symptoms associated with other symptoms or signs suggesting serious organic disease (e.g., anorexia and weight loss) or in patients aged >45 years |
C. Dysphagia or odynophagia |
D. Esophageal reflux symptoms, which are persistent or recurrent despite appropriate therapy |
E. Persistent vomiting of unknown cause |
F. Other diseases in which the presence of upper GI pathology might modify other planned management. Examples include patients who have a history of ulcer or GI bleeding who are scheduled for organ transplantation, long-term anticoagulation, or chronic nonsteroidal anti-inflammatory drug therapy for arthritis and those with cancer of the head and neck |
G. Familial adenomatous polyposis syndromes |
H. For confirmation and specific histologic diagnosis of radiologically demonstrated lesions: |
1. Suspected neoplastic lesion |
2. Gastric or esophageal ulcer |
3. Upper tract stricture or obstruction |
I. GI bleeding: |
1. In patients with active or recent bleeding |
2. For presumed chronic blood loss and for iron deficiency anemia when the clinical situation suggests an upper GI source or when colonoscopy result is negative |
J. When sampling of tissue or fluid is indicated |
K. In patients with suspected portal hypertension to document or treat esophageal varices |
L. To assess acute injury after caustic ingestion |
M. Treatment of bleeding lesions such as ulcers, tumors, vascular abnormalities (e.g., electrocoagulation, heater probe, laser photocoagulation, or injection therapy) |
N. Banding or sclerotherapy of varices |
O. Removal of foreign bodies |
P. Removal of selected polypoid lesions |
Q. Placement of feeding or drainage tubes (peroral, PEG, or percutaneous endoscopic jejunostomy) |
R. Dilation of stenotic lesions (e.g., with transendoscopic balloon dilators or dilation systems by using guidewires) |
S. Management of achalasia (e.g., botulinum toxin, balloon dilation) |
T. Palliative treatment of stenosing neoplasms (e.g., laser, multipolar electrocoagulation, stent placement) |
U. Endoscopic therapy for intestinal metaplasia |
V. Intraoperative evaluation of anatomic reconstructions typical of modern foregut surgery (e.g., evaluation of anastomotic leak and patency, fundoplication formation, pouch configuration during bariatric surgery) |
W. Management of operative adverse events (e.g., dilation of anastomotic strictures, stenting of anastomotic disruption, fistula, or leak in selected circumstances) |
2. EGD is generally not indicated for evaluating: |
A. Symptoms that are considered functional in origin (there are exceptions in which an endoscopic examination may be done once to rule out organic disease, especially if symptoms are unresponsive to therapy) |
B. Metastatic adenocarcinoma of unknown primary site when the results will not alter management |
C. Radiographic findings of: |
1. Asymptomatic or uncomplicated sliding hiatal hernia |
2. Uncomplicated duodenal ulcer that has responded to therapy |
3. Deformed duodenal bulb when symptoms are absent or respond adequately to ulcer therapy |
3. Sequential or periodic EGD may be indicated: |
A. Surveillance for malignancy in patients with premalignant conditions (ie, Barrett's esophagus) |
4. Sequential or periodic EGD is generally not indicated for: |
A. Surveillance for malignancy in patients with gastric atrophy, pernicious anemia, or prior gastric operations for benign disease |
B. Surveillance of healed benign disease such as esophagitis or gastric or duodenal ulcer |
C. Surveillance during repeated dilations of benign strictures unless there is a change in status |
Comments