INDICATIONS

OF UPPER
GI ENDOSCOPY
 Diagnostic EGD

Therapeutic EGD

Screening EGD

Sequential or Periodic
Diagnostic EGD
 Diagnostic EGD

According to the ASGE Consensus

Statement Guidelines (2000-2006), esophago-
gastroduodenoscopy (EGD) for diagnostic
purpose(s) is considered medically necessary
for any of the following:
 Upper abdominal symptoms which persist
despite an appropriate trial of therapy

1. Upper abdominal symptoms associated with

other signs/symptoms suggesting serious
organic disease (e.g., anorexia and weight loss)
or in patients over 45 years of age
Dysphagia or odynophagia
 Esophageal reflux symptoms that are persistent
or recurrent despite appropriate therapy

1. Persistent vomiting of unknown origin

1. Other disease in which the presence of upper GI

pathology might modify other planned
management
 Familial adenomatous polyposis syndromes
1. For confirmation and specific histological
diagnosis of radiographically demonstrated
lesions:
a. Suspected neoplastic lesion
b. Gastric or esophageal ulcer
c. Upper GI stricture or obstruction
1. Gastrointestinal bleeding:
a. In patients with active or recent bleeding
b. For presumed chronic blood loss and for iron deficiency
anemia when the clinical situation suggests an upper GI
source or when colonoscopy is negative
c. When surgical therapy is contemplated
d. When portal hypertension or aorto-enteric fistula is
suspected
e. When re-bleeding occurs after acute self-limited blood loss
 When sampling of upper GI tissue or fluid is
indicated

To assess acute injury after caustic ingestion

1. Intraoperative EGD when necessary to clarify

location or pathology of a lesion
1. Documentation of esophageal varices in
patients with suspected portal hypertension

1. Refusal to eat or failure to thrive in very young

or uncommunicative child
(Rudolph [North American Society for Pediatric
Gastroenterology and Nutrition] [NASPGHAN],
2001; Squires [NASPGHAN], 1996)
 Therapeutic EGD

According to the ASGE Consensus

Statement Guidelines (2000-2006), esophago-
gastroduodenoscopy (EGD) for therapeutic
purpose(s) is considered medically necessary
for any of the following:
 Treatment of bleeding from lesions such as
ulcers, tumors, vascular malformations (e.g.,
electrocoagulation or injection therapy)
1. Sclerotherapy and/or band ligation for bleeding
from esophageal or proximal gastric varices
(For esophageal varices, procedure may be
repeated every two to four weeks until varices
are eradicated) (Qureshi [ASGE], 2005)
1. Foreign body removal

1. Removal of selected polypoid lesions

1. Placement of feeding tubes (per oral,

percutaneous endoscopic gastrostomy,
percutaneous endoscopic jejunostomy)
1. Dilation of stenotic lesions of the esophagus,
pylorus or duodenum (e.g., with
transendoscopic balloon dilators or dilating
systems employing guidewires)

1. Management of achalasia (dilatation, Botulinum

toxin)

1. Palliative therapy of stenosing neoplasms

 Screening EGD

According to the ASGE Consensus

Statement Guidelines (2000-2006), esophago-
gastroduodenoscopy (EGD) for screening
purpose(s) is considered medically necessary
for any of the following:
 Patients who have longstanding (5 years or
more) gastroesophageal reflux disease (GERD)
to rule out Barrett’s esophagus (Hirota [ASGE)],
2006)
1. Patients at high risk for squamous cell cancer of the
esophagus including, but not limited to:
A. Patients with tylosis (surveillance should begin
at age 30 years)
B. Fanconi’s anemia
C. Patients with caustic injury (surveillance should
begin 15 to 20 years after caustic ingestion)
(Hirota [ASGE], 2006; Wang [American Gastrointestinal
Association], 2005)
 Sequential or Periodic
Diagnostic EGD

According to the ASGE Consensus

Statement Guidelines (2000-2006), Sequential
or periodic diagnostic esophagogastro-
duodenoscopy (EGD) is considered medically
necessary for the following :
Pre-malignant conditions including, but not limited to:
a. Follow-up of patients with prior
adenomatous gastric polyps
b. Follow-up of patients with Familial
Adenomatous Polyposis (FAP)
c. Follow-up of patients with established
Barrett’s esophagus
d. Follow up of patients with tylosis
e. Follow up of patients with caustic injury
1. Follow up of selected esophageal, gastric or stomal
ulcers if likely to alter clinical management
Follow up for adequacy of prior sclerotherapy
and/or band ligation of esophageal varices (could
be every 6-24 months depending on clinical status)
For surveillance for patients with portal
hypertension or cirrhosis

For surveillance for rejection or other complications

following intestinal transplantation.
Not Medically Necessary EGD

According to the ASGE Consensus

Statement Guidelines (2000-2006),
esophagogastro-duodenoscopy (EGD)
is considered not medically necessary
for the following :
 Distress that is chronic, non-progressive and
atypical for known organic disease, and is
considered functional in origin

1. Uncomplicated heartburn responding to medical

therapy

1. Metastatic adenocarcinoma of unknown primary

site when the results will not alter management
1. X-ray findings of:
– Asymptomatic or uncomplicated sliding hiatal
hernia, or
– Uncomplicated duodenal ulcer that is
responding to therapy, or
– Deformed duodenal bulb seen on upper GI
when symptoms are absent or responding
adequately to ulcer therapy.

1. Routine screening of the upper gastrointestinal

tract
1. Patients without current gastrointestinal symptoms about
to undergo elective surgery for non-upper
gastrointestinal disease

1. Confirming Helicobacter pylori (H. pylori) eradication

1. Surveillance of healed benign disease such as

esophagitis, gastric or duodenal ulcer

For surveillance for patients with portal hypertension or

cirrhosis Surveillance for malignancy in patients with
gastric atrophy, pernicious anemia or treated achalasia
1. Routine surveillance after prior gastric operation for
benign disease (including non dysplastic gastric
polyps)

1. Surveillance during repeated dilatations of benign

strictures unless there is a change in status

For surveillance for patients with portal

hypertension or cirrhosis Isolated pylorospasm,
known congenital hypertrophic pyloric stenosis,
constipation and encopresis, or inflammatory bowel
disease responding to therapy.
 Indication
1 Upper abdominal symptoms in patients with age >45 y
2 Upper abdominal symptoms persistent despite therapy
3 Esophageal reflux symptoms persistent despite therapy

Upper abdominal symptoms associated with sign/symptoms suggesting serious

4
organic disease

5 Follow-up of gastric/esophageal ulcer

6 Presumed chronic blood loss/iron deficiency anemia
7 Patients with active or recent GI bleeding
8 Sampling of tissue or fluid
9 Dysphagia/odynophagia
10 Periodic surveillance of Barrett's esophagus
11 To document or treat esophageal varices
12 Placement of feeding or drainage tubes
13 Dilation of stenotic lesions
14 Other system disease with upper GI pathology
15 Other ASGE indications