Routine Esophagogastroduodenoscopy Before Upper Endoscopic Ultrasound for Non-Luminal Indications: Clinical Value and Findings From a Large Single-Center Experience.

Document Type

Article

Publication Date

11-2025

Publication Title

Annals of Gastroenterology

Abstract

BACKGROUND: Most echoendoscopes are oblique viewing instruments, potentially limiting their value in mucosal evaluation during upper endoscopic ultrasound (EUS) examinations. This raises at least the potential for missed mucosal lesions. While esophagogastroduodenoscopy (EGD) prior to EUS may mitigate this, performing EGD adds both cost and time to upper EUS. This study evaluated the utility of routine EGD before EUS in asymptomatic patients.

METHODS: We performed a retrospective, single-center, cohort study including 626 patients undergoing EUS for pancreaticobiliary/mediastinal indications over a 5-year period (2017-2022). Exclusion criteria included luminal symptoms or prior upper gastrointestinal surgery. Clinically significant EGD findings and their impact on management were analyzed.

RESULTS: Among 568 patients who underwent EGD before EUS, 16.8% (n=95) had clinically significant lesions, including reflux esophagitis (32.7%), Barrett's esophagus (12.7%) and gastritis (17.3%). Additionally, 16.6% (n=94) exhibited findings affecting the feasibility of EUS (e.g., strictures, large hiatal hernias). Management changes occurred in 54.3% of cases, primarily biopsies (54.3%) and medication initiation (36.6%). Only 4.6% had a prior EGD within 6 months of their EUS.

CONCLUSIONS: Routine EGD before EUS can detect clinically significant mucosal lesions in asymptomatic patients, as well as anatomical factors influencing EUS performance. These findings support considering the incorporation of routine EGD into pre-EUS evaluations to optimize diagnostic accuracy and patient management.

Volume

38

Issue

6

First Page

720

Last Page

724

DOI

10.20524/aog.2025.1015

ISSN

1108-7471

PubMed ID

41586400

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