Indications

Diagnostic

Most patients referred for endoscopy complain of upper abdominal symptoms that come under the general heading of dyspepsia (Axon ATR, Bell GD, Jones RH, Quine MA, McCloy RF, 1995) . The diseases most commonly sought by endoscopy are reflux oesophagitis (and its complications), oesophageal varices, oesophageal cancer, gastric ulcer, gastric cancer, duodenal ulcer, and coeliac disease.

There are two main purposes of this investigation:

• to identify the cause of symptoms in order to start suitable treatment,
• to exclude organic gastrointestinal (GI) disease.

Standard diagnostic functions of GI endoscopy include inspection, biopsy, photography, and video recording (>Fig. 1). Direct visualization is possible for focal benign or malignant lesions, diffuse mucosal changes, bleeding sites, luminal obstruction, motility, and extrinsic compression by contiguous structures (American Society for Gastrointestinal Endoscopy, 2000) . Among other diagnostic tools used with GI endoscopy are: brush cytology and endoscopic ultrasonography (EUS).

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Fig. 1. A physician performing GI endoscopy with biopsy

The indications and relative contraindications for doing each of the endoscopic diagnostic procedures are based on a critical review of available information and broad clinical consensus (American Society for Gastrointestinal Endoscopy, 2000) .

General indications for GI endoscopy

1. If a change in management is probable based on results of endoscopy (but when the results will not contribute to a management choice, GI endoscopy is generally not indicated).
2. If an empiric trial of therapy for a suspected benign GI disease has been unsuccessful.
3. As the initial diagnostic method alternative to radiographic studies.
4. When a primary therapeutic procedure is considered.
5. As a periodic follow-up of healed benign disease if surveillance of a pre-malignant condition is warranted.

General contraindications to GI endoscopy

1. When the risks to patient health or life can outweigh the most favourable benefits of the procedure.
2. When adequate patient cooperation or informed consent cannot be obtained.
3. When a perforated internal organ is known or suspected.

More specific indications and contraindications are listed below (in the description of individual procedures).

Therapeutic

The most common therapeutic endoscopic procedures in gastroenterology include (Wrightson WR (ed), 2006) , (American Society for Gastrointestinal Endoscopy, 2000) :

1. treatment of GI bleeding with injection, banding, coagulation or sclerotherapy,
2. dilatation of strictures,
3. removal of foreign bodies,
4. polypectomy, and
5. the placement of percutaneous gastrostomy tubes for feeding.

Glossary

base

A proton acceptor or H+ ion acceptor