Esophagogastroduodenoscopy (EGD) Guidelines

EGD is covered for specified organic upper-GI indications (e.g., new dyspepsia ≥60, dyspepsia <60 after failed H. pylori test‑and‑treat or 4‑week PPI, any age with red‑flag symptoms such as weight loss, GI bleeding, iron‑deficiency anemia, dysphagia/odynophagia, persistent vomiting, abnormal imaging, suspected malignancy), for Barrett’s screening/surveillance and gastric‑ulcer surveillance per stated intervals, pre/post anti‑reflux evaluation, pH monitoring placement, and a one‑time EGD to exclude organic disease in functional complaints; endomicroscopy is investigational and routine/repeated EGD for isolated functional or uncomplicated asymptomatic conditions (e.g., belching/bloating alone, uncomplicated sliding hiatal hernia, healed benign disease) is excluded or discouraged. Key requirements include documentation of prior therapies/tests and specific trial durations (e.g., PPI trials: 4 weeks for dyspepsia <60; 8 weeks once‑daily or 4 weeks twice‑daily for typical GERD; 8–12 weeks twice‑daily for extra‑esophageal symptoms), H. pylori test‑and‑treat when indicated, relevant labs/imaging/pathology reports, recent clinical evaluation (preferably within 60 days), cardiac clearance when indicated, and adherence to specified biopsy/pathology confirmation and surveillance intervals.