Upper GI endoscopy overused: New guidelines advise stricter criteria

The American College of Physicians Clinical Guidelines Committee has released a new evidence-based clinical policy paper revising the guidelines for upper endoscopy use in most patients. During the procedure, known as EGD among clinicians for esophago-gastro-duodenoscopy, a tiny flexible camera called an endoscope is inserted down the patient s throat so the physician can visualize the upper GI tract: esophagus, stomach and duodenum. The goal is to detect ailments including reflux esophagitis (the most common cause of heartburn), ulcers of the stomach and duodenum, and potentially precancerous lesions known as Barrett s esophagus.

But routine use of upper endoscopy for most patients with relatively brief gastroesophageal reflux disease (heartburn) does not improve patient health, and is associated with needless expense and preventable harms. The new guidelines, published in the Annals of Internal Medicine, now advise that upper endoscopy should not be routinely performed in women of any age or in men under the age of 50 with GERD symptoms, because incidence of cancer or other serious lesions is very low in these populations.

Patients have the right to be cognizant of this, says ACSH s Dr. Gilbert Ross. Doctors should be aware of these guidelines, and not recommend this often unnecessary procedure for every patient complaining of heartburn. However, if a patient s complaints do not resolve after six weeks or so of anti-acid therapy, or if they have a history of esophageal or ulcer problems, or bleeding, then careful evaluation and follow-up is necessary.