Routine esophagogastroduodenoscopy before upper endoscopic ultrasound for non-luminal indications: clinical value and findings from a large single-center experience

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 ma  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.

Keywords Esophagogastroduodenoscopy, endoscopic ultrasound, upper gastrointestinal tract, diagnostic accuracy, luminal lesions

Ann Gastroenterol 2025; 38 (6): 720-724