Esophageal Endoscopy

Endoscopic evaluation is necessary to confirm or establish a diagnosis in most esophageal

disorders.

1.1. Specific Indications*

A. Upper abdominal symptoms that persist despite an appropriate trial of therapy;

B. Upper abdominal symptoms associated with other symptoms or signs

suggesting serious organic disease (e.g., anorexia and weight loss) or in

patients over 45 years of age;

C. Dysphagia or odynophagia;

D. Esophageal reflux symptoms, which are persistent or recurrent despite

appropriate therapy;

E. Persistent vomiting of unknown cause;

F. Other diseases in which the presence of upper gastrointestinal (GI) pathology

might modify other planned management. Examples include, patients who

have a history of ulcer or GI bleeding, who are scheduled for organ transplan-

tation, long-term anticoagulation, or chronic nonsteroidal anti-inflammatory

drug therapy for arthritis and those with cancer of the head and neck;

G. Familial polyposis syndromes;

H. For confirmation and specific histologic diagnosis of radiologically demon-

strated lesions such as

1. suspected neoplastic lesion,

2. gastric or esophageal ulcer,

3. upper tract stricture or obstruction;

I. GI bleeding

1. in patients with active or recent bleeding,

2. for presumed chronic blood loss and for iron deficiency anemia when the

clinical situation suggests an upper GI source or when colonoscopy is

negative;

J. When sampling of tissue or fluid is indicated;

K. In patients with suspected portal hypertension to document or treat esophageal

varices;

L. To assess acute injury after caustic ingestion;

M. Treatment of bleeding lesions such as ulcers, tumors, and vascular abnormal-

ities (e.g., electrocoagulation, heater probe, laser photocoagulation, or

injection therapy);

N. Banding or sclerotherapy of varices;

O. Removal of foreign bodies;

P. Removal of selected polypoid lesions;

Q. Placement of feeding or drainage tubes (peroral, percutaneous endoscopic

gastrostomy, and percutaneous endoscopic jejunostomy);

R. Dilatation of stenotic lesions (e.g., with transendoscopic balloon dilators or

dilation systems employing guide wires);

S. Management of achalasia (e.g., botulinum toxin, balloon dilation);

T. Palliative treatment of stenosing neoplasms (e.g., laser, multipolar electro-

coagulation, and stent placement).