Intended for healthcare professionals

Education And Debate

Guidelines on appropriate indications for upper gastrointestinal endoscopy

BMJ 1995; 310 doi: (Published 01 April 1995) Cite this as: BMJ 1995;310:853
  1. A T R Axon, consultant physiciana,
  2. G D Bell, consultant gastroenterologistb,
  3. R H Jones, Wolfson professorc,
  4. M A Quine, research fellowd,
  5. R F McCloy, senior lecturere
  1. a Centre for Digestive Diseases, General Infirmary, Leeds LS1 3EX
  2. b Ipswich Hospital NHS Trust, Ipswich IP4 5PD
  3. c Department of General Practice, United Medical and Dental Schools of Guy's and St Thomas's Hospitals, London SE11 6SP
  4. d Royal College of Surgeons, London WC2A 3PN
  5. e University Department of Surgery, Manchester Royal Infirmary, Manchester M13 9WL
  1. Correspondence to: Dr Axon.
  • Accepted 12 December 1994

Upper gastrointestinal endoscopy is a valuable diagnostic tool, but for an endoscopy service to be effective it is essential that it is not overloaded with inappropriately referred patients. A joint working party in Britain has considered the available literature on indications for endoscopy, assessed standard practice through a questionnaire, and audited randomly selected cases using an independent panel of experts and an American database system. They used these data to produce guidelines on the appropriate and inappropriate indications for referral for endoscopy, although they emphasise that under certain circumstances there may be reasons to deviate from the advice given. The need for endoscopy is most difficult to judge in patients with dyspepsia, and this aspect is discussed in detail. Early endoscopy will often prove more cost effective than delaying until the indications are clearer.


Most patients referred for endoscopy complain of symptoms that come under the general heading of dyspepsia.1 2 3 4 5 Gastrointestinal symptoms are responsible for about 10% of the work of general practitioners,6 with upper abdominal symptoms (principally dyspepsia) accounting for about half. The severity and frequency of symptoms alone does not predict the likelihood of consultation, however; concerns about the meaning of symptoms, particularly in terms of malignancy and heart disease, play an important part in determining whether a patient consults. This is reflected in the finding that dyspeptic patients with negative findings on endoscopy have greatly reduced consultation and prescribing rates after the procedure.7

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. The main purpose of the investigation is to identify the cause of symptoms in order to start suitable treatment. A secondary reason is to exclude organic upper gastrointestinal disease so that …

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