title: The utility of esophagogastroduodenoscopy before endoscopic ultrasonography in patients undergoing endoscopic ultrasonography for pancreatico-biliary and mediastinal indications.
abstract: BACKGROUND
  Oblique-viewing echoendoscopes may miss luminal lesions. There is no consensus on whether to routinely perform esophagogastroduodenoscopy (EGD) before endoscopic ultrasonography (EUS). Currently, practice patterns are variable and prospective data are needed.
  
  
  OBJECTIVE
  : To determine the proportion of clinically meaningful lesions detected when EGD is performed routinely before EUS.
  
  
  METHODS
  This was a multicenter prospective cohort study conducted at tertiary referral center and large community practice. Patients undergoing EUS for pancreatico-biliary and mediastinal indications were enrolled.
  
  
  RESULTS
  The primary outcome was the proportion of patients with a clinically meaningful lesion found on EGD. This was a combined outcome defined as any lesion that would alter medical management, or impact the subsequent EUS examination.
  
  
  RESULTS
  Two hundred four patients were included in the final analysis. Clinically meaningful lesions were found on EGD in 45 patients [22.1%; 95% confidence interval (CI), 16.4-27.8]. Lesions that altered medical management were found in 32 patients (15.7%; 95% CI, 10.7-20.7). Lesions impacting the subsequent EUS examination were found in 20 patients (9.8%; 95% CI, 5.7-13.9). Clinically meaningful lesions found were (number of patients): esophagitis (14), ulcer (9), ring/stricture (7), large hiatal hernia (6), hyperplastic gastric polyp (5), Barrett esophagus (3), surgically altered anatomy (2), neoplastic lesion (2), subepithelial mass/GIST (1), stenosis (1), diverticulum (1), and fistula (1).
  
  
  CONCLUSIONS
  EGD before EUS may detect enough clinically meaningful lesions to support the routine performance of EGD before EUS.
authors: *Yale University School of Medicine, Section of Digestive Diseases §Yale School of Public Health, Center for Analytical Sciences; New Haven ‡VA Connecticut Healthcare System, Section of Digestive Diseases, West Haven, CT †Minnesota Gastroenterology Group, Minneapolis, MN ∥Section of Gastroenterology, University of Chicago, Chicago, IL.
authors: Ara B
authors: AB
authors: Sahakian
authors: Harry R
authors: HR
authors: Aslanian
authors: Mohit
authors: M
authors: Mehra
authors: Federico
authors: F
authors: Rossi
authors: Loren
authors: L
authors: Laine
authors: Mayra
authors: M
authors: Sanchez
authors: Maria M
authors: MM
authors: Ciarleglio
authors: Vijay
authors: V
authors: Adimoolam
authors: Uzma D
authors: UD
authors: Siddiqui
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001660:Biliary Tract Diseases / Q000175:diagnosis* / Q000503:physiopathology; D015331:Cohort Studies; D016145:Endoscopy, Digestive System / Q000379:methods*; D019160:Endosonography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008477:Mediastinal Diseases / Q000175:diagnosis* / Q000503:physiopathology; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000175:diagnosis* / Q000503:physiopathology; D011446:Prospective Studies; D055815:Young Adult