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List of OGD and EGD Indications

OGD Indications

Symptoms suggestive of upper gastrointestinal cancer:

  • Dysphagia
  • Unexplained upper abdominal pain and weight loss
  • Upper abdominal mass with or without dyspepsia
  • Persistent vomiting & weight loss
  • Unexplained weight loss
  • Iron deficiency anaemia
  • Unexplained worsening of dyspepsia
  • Patients aged ≥45 years with unexplained & persistent recent-onset dyspepsia (after stopping treatment with PPIs)
    *Age cut-off may differ based on geographical risks
  • Abnormal or suspicious findings on barium studies, CT or US scanning

Other indications:

  • Patients with haematemesis and/or melaena
  • To confirm healing of oesophageal or gastric ulcer
  • Persistent long term reflux, odynophagia or dyspepsia unresponsive to 6 weeks treatment in primary care
  • Coeliac disease diagnosis (& follow up of non-responders)
  • Surveillance of high risks/premalignant conditions eg gastric intestinal metaplasia/dysplasia, Barrett’s oesophagus
  • To take small bowel biopsies to investigate malabsorption or enteropathy
  • In patients with an adenocarcinoma of unknown primary after discussion at MDT
  • Surveillance for gastric dysplasia or in patients with a strong family history of gastric carcinoma
  • Surveillance or screening in patients with FAP because of the risk of duodenal polyps
  • Surveillance for oesophago-gastric varices in patients with suspicion of portal hypertension (eg, decompensated liver disease, cirrhosis on liver biopsy or equivalent non-invasive testing, presence of varices on abdominal imaging)
  • Elevated Relevant tumour marker
  • GI Cancer Screening of malignancy of unknown primary

References

  1. Referral guidelines for suspected cancer. NICE Clinical guidelines, CG 27 (2005)
  2. Guidelines for the Management of Oesophageal and Gastric Cancer. Allum WH, Blazeby JM, Griffin SM et al. Gut 2011; 60:1449-1472
  3. Acute Upper GI Bleeding. NICE Clinical Guideline CG 141 (2012)
  4. Managing Dyspepsia in Primary Care. NICE Clinical Guideline CG17 (2004)
  5. Coeliac disease. NICE Clinical Guideline CG 86 (2009)
  6. BSG Guidelines for the diagnosis and management of Barrett’s columnar-lined oesophagus. August 2005.
  7. Guidelines for the investigation of chronic diarrhoea, 2nd edition. P D Thomas, A Forbes, J Green et al. Gut 2003; 52 (Suppl V):v1–v15
  8. Guidelines for colorectal cancer screening and surveillance in moderate and high risk groups (update from 2002). Gut 2010; 59: 666-690
  9. Jalan R and Hayes PC. UK Guidelines for management of variceal haemorrhage in cirrhotic patients. June 2000. http://www.bsg.org.uk/clinical-guidelines/liver/uk-guidelines-in-themanagement-of-variceal-haemorrhage-in-cirrhotic-patients.
  10. Guidelines for the Management of Iron Deficiency Anaemia. Goddard AF, James MW, McIntyre AS, Scott BB. Gut 2011; 60:1309-1316
  11. Guidelines for the management of inflammatory bowel disease in adults. Mowat C, Cole A, Windsor A, et al. Gut 2011; 60(5): 571-607
  12. Colonoscopic surveillance for prevention of colorectal cancer in people with ulcerative colitis, Crohn’s disease or adenomas. NICE Clinical Guideline CG 118 (2011)

EGD Indications

  • Upper abdominal symptoms, which persist despite an appropriate trial of therapy
  • Upper abdominal symptoms associated with other symptoms or signs suggesting serious organic disease (eg, anorexia and weight loss) or in patients aged >45 years
  • Dysphagia or odynophagia
  • Esophageal reflux symptoms, which are persistent or recurrent despite appropriate therapy
  • Persistent vomiting of unknown cause
  • 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
  • Familial adenomatous polyposis syndromes
  • For confirmation and specific histologic diagnosis of radiologically demonstrated lesions:
    • Suspected neoplastic lesion
    • Gastric or esophageal ulcer
    • Upper tract stricture or obstruction
  • GI bleeding:
    • In patients with active or recent bleeding
    • 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
  • When sampling of tissue or fluid is indicated
  • In patients with suspected portal hypertension to document or treat esophageal varices
  • To assess acute injury after caustic ingestion
  • Treatment of bleeding lesions such as ulcers, tumors, vascular abnormalities (eg, electrocoagulation, heater probe, laser photocoagulation, or injection therapy)
  • Banding or sclerotherapy of varices
  • Removal of foreign bodies
  • Removal of selected polypoid lesions
  • Placement of feeding or drainage tubes (peroral, PEG, or percutaneous endoscopic jejunostomy)
  • Dilation of stenotic lesions (eg, with transendoscopic balloon dilators or dilation systems by using guidewires)
  • Management of achalasia (eg, botulinum toxin, balloon dilation)
  • Palliative treatment of stenosing neoplasms (eg, laser, multipolar electrocoagulation, stent placement)
  • Endoscopic therapy for intestinal metaplasia
  • Intraoperative evaluation of anatomic reconstructions typical of modern foregut surgery (eg, evaluation of anastomotic leak and patency, fundoplication formation, pouch configuration during bariatric surgery)
  • Management of operative adverse events (eg, dilation of anastomotic strictures, stenting of anastomotic disruption, fistula, or leak in selected circumstances)
  • Surveillance for malignancy in patients with premalignant conditions (ie, gastric intestinal metaplasia, Barrett’s esophagus)