The Utility of an Upper Esophagogastroduodenoscopy in Patients Who Are Scheduled to Undergo an Upper Endoscopic Ultrasound Examination

Introduction: The use of an upper endoscopic ultrasound (EUS) has evolved from primarily a diagnostic modality to use in various therapeutic applications. Although many endoscopists perform an esophagogastroduodenoscopy (EGD) prior to EUS examination, there are limited data regarding the clinical utility of this practice. In this study we examine the utility of a screening EGD directly prior to EUS. Methods: This single-center, multiple-operator study in a tertiary care hospital involved a retrospective analysis of 145 EUS encounters for 135 patients with a visual endoscopic exam performed directly prior to EUS. Data was collected on variables such as patient demographics, indication for EUS, prior study indicating EUS, visual findings on EGD performed immediately prior, EUS visual exam findings, and final pathology if biopsies were taken. The primary outcome measured whether a visual exam with EGD directly prior to EUS precluded continuation to the scheduled EUS examination. Results: A total of 145 EUS encounters for 135 patients were analyzed. Abnormal imaging and pancreatic masses were the two most common indications for EUS. The majority of the prior studies indicating need for EUS exam were CT and MRI scans (54%), while prior EGD exams indicated need for EUS 23% of the time. 143 (98.6%) encounters proceeded to EUS regardless of visual endoscopic findings directly prior. Two encounters did not proceed to EUS. The first demonstrated a duodenal mass on EGD that was deemed amenable to endoscopic mucosal resection. The second encounter also revealed a duodenal mass on EGD but was not evaluated by ultrasound as the scope could not be advanced further. Conclusion: Our observations suggest that an EGD for visual inspection prior to EUS examination is not necessary. As imaging modalities such as MRI, CT, and EGD exams preceded the majority of referrals for EUS, and EGD findings ultimately did not halt proceeding to the scheduled EUS, visual inspection via EGD directly prior to EUS may not be warranted. However, further studies may be needed to analyze if EGD prior to EUS versus EUS examination alone would affect diagnosis and treatment of the initial indication for EUS.