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
- Referral guidelines for suspected cancer. NICE Clinical guidelines, CG 27 (2005)
- Guidelines for the Management of Oesophageal and Gastric Cancer. Allum WH, Blazeby JM, Griffin SM et al. Gut 2011; 60:1449-1472
- Acute Upper GI Bleeding. NICE Clinical Guideline CG 141 (2012)
- Managing Dyspepsia in Primary Care. NICE Clinical Guideline CG17 (2004)
- Coeliac disease. NICE Clinical Guideline CG 86 (2009)
- BSG Guidelines for the diagnosis and management of Barrett’s columnar-lined oesophagus. August 2005.
- 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
- Guidelines for colorectal cancer screening and surveillance in moderate and high risk groups (update from 2002). Gut 2010; 59: 666-690
- 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.
- Guidelines for the Management of Iron Deficiency Anaemia. Goddard AF, James MW, McIntyre AS, Scott BB. Gut 2011; 60:1309-1316
- Guidelines for the management of inflammatory bowel disease in adults. Mowat C, Cole A, Windsor A, et al. Gut 2011; 60(5): 571-607
- 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)