Routine esophagogastroduodenoscopy before upper endoscopic ultrasound for non-luminal indications: clinical value and findings from a large single-center experience
Recommended Citation
Salam R, Bassler Z, Hegde Y, Altahan O, Kitchen S, Sorser S, and Adler DG. Routine esophagogastroduodenoscopy before upper endoscopic ultrasound for non-luminal indications: clinical value and findings from a large single-center experience. Ann Gastroenterol 2025;38(6):720-724.
Document Type
Article
Publication Date
10-15-2025
Publication Title
Ann Gastroenterol
Keywords
Esophagogastroduodenoscopy; diagnostic accuracy; endoscopic ultrasound; luminal lesions; upper gastrointestinal tract
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.
PubMed ID
41586400
Volume
38
Issue
6
First Page
720
Last Page
724
