Gastroscopy: a primary diagnostic procedure.

EGD, using 1986 models of either the fiberoptic gastroscope or the videoscope, is a safe and accurate procedure that can be performed by any physician trained in the technique of endoscope passage. It may be performed at large medical centers or small rural hospitals, outpatient clinics, or even private offices. Patients themselves have indicated preference for endoscopic evaluation over the double-contrast barium meal after they have experienced both procedures. The short time of procedure, its accuracy, safety, and its relative lack of discomfort to the patient lend it readily to being an initial component in the primary evaluation of symptoms of abdominal distress, gastrointestinal bleeding, dysphagia, esophageal reflux, persistent vomiting, and odynophagia. It is essential in the evaluation of complications of esophageal reflux and the evaluation of abnormal radiological findings in the upper gastrointestinal tract. It should never be overlooked in evaluating the patient with iron deficiency anemia of unknown etiology. Economic pressures have already moved EGD from the surgery wards to endoscopy labs and to the outpatient setting. These same forces will project more physicians into the role of the diagnostic endoscopist and the patient will benefit by decreased medical costs, quicker diagnosis and treatment, and enhanced continuity of care.