Gastroenterology and Hepatology


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OGDS is generally indicated for evaluating:

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 > 45 years old

C. Dysphagia or odynophagia

D. Oesophageal reflux symptoms that are persistent or recurrent despite appropriate therapy

E. Persistent vomiting of unknown cause after investigations

F. Other diseases in which the presence of upper GI pathologic conditions 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, antiplatelets or long-term nonsteroidal anti-inflammatory drug therapy)

G. Familial adenomatous polyposis syndromes

H. For confirmation and specific histologic diagnosis of radiologically demonstrated lesions

     1. Suspected neoplastic lesion

     2. Gastric or esophageal ulcer

     3. Upper tract stricture or obstruction

I. GI bleeding (haematemesis, malaena, haematochezia)

     1. In patients with active or recent bleeding

     2. For presumed chronic blood loss and for iron deficiency anaemia when the clinical situation suggests an upper GI source or when colonoscopy results are negative

J. When sampling of tissue or fluid is indicated

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

L. To assess acute injury after caustic ingestion

M. Treatment of bleeding lesions such as ulcers, tumours, vascular abnormalities (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, percutaneous endoscopic jejunostomy)

R. Dilation of stenotic lesions (e.g., with transendoscopic balloon dilators or dilation systems using guidewires)

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

T. Palliative treatment of stenosing neoplasms (e.g., laser, multipolar electrocoagulation, stent


OGDS is generally not indicated for evaluating:

A. Symptoms that are considered functional in origin (there are exceptions in which an endoscopic examination may be done once to rule out organic disease, especially if symptoms are unresponsive to therapy)

B. Metastatic adenocarcinoma of unknown primary site when the results will not alter management

C. Radiographic findings of

     1. Asymptomatic or uncomplicated sliding hiatal hernia

     2. Uncomplicated duodenal ulcer that has responded to therapy

     3. Deformed duodenal bulb when symptoms are absent or respond adequately to ulcer therapy

Sequential or periodic OGDS may be indicated:

A. Surveillance for malignancy in patients with premalignant conditions (ie, Barrett’s esophagus)

Sequential or periodic OGDS is generally not indicated for:

A. Surveillance for malignancy in patients with gastric atrophy, pernicious anemia, or prior gastric operations for benign disease

B. Surveillance of healed benign disease such as esophagitis or gastric or duodenal ulcer

C. Surveillance during repeated dilations of benign strictures unless there is a change in status

Colonoscopy Indications are:


  1. Positive FOBT
  2. Haematochezia
  3. Iron deficiency anaemia
  4. Malaena with negative oesophagogastroduodenoscopy

Screening for colorectal cancer:

Average risk 10 yearly (begin at age 50 y)

Single FDR (first degree relative) with cancer (or adenomas) at age ≥60 y [10 y interval (begin at age 40 y)]

≥2 FDRs with cancer (or adenomas) or 1 FDR diagnosed at age <60 y [5 y interval (begin at age 40 y or 10 y younger than diagnosis, whichever is earlier)]

Prior endometrial or ovarian cancer diagnosed at age <50 y [5 y interval]

HNPCC (begin age 20-25 y) 1-2 yearly

Abdominal pain, altered bowel habit


Positive sigmoidoscopy (large polyp or polyp of <1 cm shown to be an adenoma)


Postadenoma resection

1-2 tubular adenomas of <1 cm 5-10 y interval

3-10 adenomas or adenoma with villous features, ≥1 cm or with HGD 3 y interval

>10 adenomas <3 y interval

Sessile adenoma of ≥2 cm, removed piecemeal 2-6 m interval

Postcancer resection: Clear colon, then in 1 y, then 3 y, then 5 y


Ulcerative colitis, Crohn’s colitis surveillance 2-3 yearly,

 after 8 y (pancolitis) or 15 y of left-sided colitis onset of symptoms



edited 13th July 2010