Indications
Esophagogastroduodenoscopy is primarily indicated a) to biopsy the gastrointestinal mucosa in patients with clinical signs of gastrointestinal disease, such as vomiting, diarrhea, weight loss, anorexia, or hypoalbuminemia; b) to detect and remove foreign bodies; c) to detect a gastric outflow obstruction and determine the cause of such an outflow obstruction; d) to look for sites of upper GI bleeding; e) to inspect and /or biopsy the esophagus in patients suspected of having esophagitis or anatomic lesions of the esophagus; f) to dilate benign esophageal strictures; g) to help place gastrostomy tubes; and h) to remove polyps.1-3 Colonoileoscopy is primarily indicated a) to biopsy the ileum in patients with small bowel disease; b) to biopsy the colon in patients with chronic colonic disease that is either non-responsive to therapeutic trials or that is characterized by concurrent hypoalbuminemia, weight loss, or systemic signs of illness; c) to determine the cause of persistent hematochezia or dyschezia; and d) to examine patients with known /suspected polyps or masses of the large bowel.4 However, colonoscopy is done less frequently than gastroduodenoscopy as large bowel disease can often be effectively diagnosed and treated using less-invasive modalities.
Imaging is typically performed shortly before gastroduodenoscopy or colonoileoscopy.
Radiographic imaging and especially abdominal ultrasonography may reveal evidence of infiltrative disease that is out of reach of the endoscope (e.g., mid-jejunum), free air or fluid (suggestive of a perforation), or widespread infiltrative disease (e. g., metastatic disease) that can be diagnosed by less invasive means (e.g., ultrasound-guided fine needle aspiration). Abdominal ultrasound is relatively specific but not as sensitive for diagnosing infiltrative disease. Thus, it can be appropriate to endoscopically biopsy the GI tract even if there is no ultrasonographic evidence of infiltrative disease, which is the case in many patients with IBD or1.5.3