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ASGE Consensus Statement Guidelines (2000-2006), esophago-gastroduodenoscopy (EGD)
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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:
1. Upper abdominal symptoms which persist
despite an appropriate trial of therapy
1. Upper abdominal symptoms which persist
despite an appropriate trial of therapy
2. 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
2. 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
3. Dysphagia or odynophagia 3. Dysphagia or odynophagia
4. Esophageal reflux symptoms that are persistent
or recurrent despite appropriate therapy
4. Esophageal reflux symptoms that are persistent
or recurrent despite appropriate therapy
5. Persistent vomiting of unknown origin 5. Persistent vomiting of unknown origin
6. Other disease in which the presence of upper GI
pathology might modify other planned management
6. Other disease in which the presence of upper GI
pathology might modify other planned management
7. Familial adenomatous polyposis syndromes 7. Familial adenomatous polyposis syndromes
8. 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
8. 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
9. 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
9. 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
10. When sampling of upper GI tissue or fluid is indicated 10. When sampling of upper GI tissue or fluid is indicated
11. To assess acute injury after caustic ingestion 11. To assess acute injury after caustic ingestion
12. Intraoperative EGD when necessary to clarify
location or pathology of a lesion
12. Intraoperative EGD when necessary to clarify
location or pathology of a lesion
13. Documentation of esophageal varices in patients with suspected portal hypertension 13. Documentation of esophageal varices in patients with suspected portal hypertension
14. 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)
14. 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:
1. Treatment of bleeding from lesions such as ulcers, tumors, vascular malformations (e.g.,
electrocoagulation or injection therapy)
1. Treatment of bleeding from lesions such as ulcers, tumors, vascular malformations (e.g.,
electrocoagulation or injection therapy)
2. 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)
2. 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)
3. Foreign body removal 3. Foreign body removal
4. Removal of selected polypoid lesions 4. Removal of selected polypoid lesions
5. Placement of feeding tubes (per oral, percutaneous
endoscopic gastrostomy, percutaneous endoscopic
jejunostomy)
5. Placement of feeding tubes (per oral, percutaneous
endoscopic gastrostomy, percutaneous endoscopic
jejunostomy)
6. Dilation of stenotic lesions of the esophagus, pylorus or duodenum (e.g., with transendoscopic balloon dilators or dilating systems employing guidewires)
6. Dilation of stenotic lesions of the esophagus, pylorus or duodenum (e.g., with transendoscopic balloon dilators or dilating systems employing guidewires)
7. Management of achalasia (dilatation, Botulinum toxin)
7. Management of achalasia (dilatation, Botulinum toxin)
8. Palliative therapy of stenosing neoplasms 8. 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:
1. Patients who have longstanding (5 years or more) gastroesophageal reflux
disease (GERD) to rule out Barrett’s esophagus (Hirota [ASGE)], 2006)
1. Patients who have longstanding (5 years or more) gastroesophageal reflux
disease (GERD) to rule out Barrett’s esophagus (Hirota [ASGE)], 2006)
2. 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)
2. 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 :
1. 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. 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
2. Follow up of selected esophageal, gastric or stomal ulcers if likely
to alter clinical management
2. Follow up of selected esophageal, gastric or stomal ulcers if likely
to alter clinical management
3. Follow up for adequacy of prior sclerotherapy and/or band ligation of esophageal varices (could be every 6-24 months depending on clinical status)
3. Follow up for adequacy of prior sclerotherapy and/or band ligation of esophageal varices (could be every 6-24 months depending on clinical status)
4. For surveillance for patients with portal
hypertension or cirrhosis
4. For surveillance for patients with portal
hypertension or cirrhosis
5. For surveillance for rejection or other complications
following intestinal transplantation.
5. 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 :
1. Distress that is chronic, non-progressive and atypical for known
organic disease, and is considered functional in origin
1. Distress that is chronic, non-progressive and atypical for known
organic disease, and is considered functional in origin
2.2. Uncomplicated heartburn responding to medical Uncomplicated heartburn responding to medical therapy therapy
2.2. Uncomplicated heartburn responding to medical Uncomplicated heartburn responding to medical therapy therapy
3.3. Metastatic adenocarcinoma of unknown primary Metastatic adenocarcinoma of unknown primary
site when the results will not alter management site when the results will not alter management
3.3. Metastatic adenocarcinoma of unknown primary Metastatic adenocarcinoma of unknown primary
site when the results will not alter management site when the results will not alter management
4. 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.
4. 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.
5.5. Routine screening of the upper gastrointestinal Routine screening of the upper gastrointestinal tract tract
5.5. Routine screening of the upper gastrointestinal Routine screening of the upper gastrointestinal tract tract
6. Patients without current gastrointestinal symptoms about to undergo
elective surgery for non-upper gastrointestinal disease
6. Patients without current gastrointestinal symptoms about to undergo
elective surgery for non-upper gastrointestinal disease
7.7. Confirming Helicobacter pylori (H. pylori) eradication Confirming Helicobacter pylori (H. pylori) eradication 7.7. Confirming Helicobacter pylori (H. pylori) eradication Confirming Helicobacter pylori (H. pylori) eradication
9. For surveillance for patients with portal hypertension or
cirrhosis Surveillance for malignancy in patients with gastric Surveillance for malignancy in patients with gastric
atrophy, pernicious anemia or treated achalasia atrophy, pernicious anemia or treated achalasia
9. For surveillance for patients with portal hypertension or
cirrhosis Surveillance for malignancy in patients with gastric Surveillance for malignancy in patients with gastric
atrophy, pernicious anemia or treated achalasia atrophy, pernicious anemia or treated achalasia
8.8. Surveillance of healed benign disease such as Surveillance of healed benign disease such as esophagitis, gastric or duodenal ulcer esophagitis, gastric or duodenal ulcer
8.8. Surveillance of healed benign disease such as Surveillance of healed benign disease such as esophagitis, gastric or duodenal ulcer esophagitis, gastric or duodenal ulcer
10. Routine surveillance after prior gastric operation for benign disease
(including non dysplastic gastric polyps)
10. Routine surveillance after prior gastric operation for benign disease
(including non dysplastic gastric polyps)
11.11. Surveillance during repeated dilatations of benign Surveillance during repeated dilatations of benign strictures unless there is a change in status strictures unless there is a change in status
11.11. Surveillance during repeated dilatations of benign Surveillance during repeated dilatations of benign strictures unless there is a change in status strictures unless there is a change in status
12. For surveillance for patients with portal hypertension or cirrhosis Isolated Isolated
pylorospasm, known congenital hypertrophic pyloric stenosis, constipation pylorospasm, known congenital hypertrophic pyloric stenosis, constipation
and encopresis, or inflammatory bowel disease responding to therapy. and encopresis, or inflammatory bowel disease responding to therapy.
12. For surveillance for patients with portal hypertension or cirrhosis Isolated Isolated
pylorospasm, known congenital hypertrophic pyloric stenosis, constipation pylorospasm, known congenital hypertrophic pyloric stenosis, constipation
and encopresis, or inflammatory bowel disease responding to therapy. 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
4 Upper abdominal symptoms associated with sign/symptoms suggesting serious 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