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New Guidelines Urge Limiting Endoscopy for GERD
Date:12/4/2012

l financial incentives and fear of being sued for not recommending a test.

The new guidelines "may be very helpful in eliminating unnecessary referral from [primary care physicians] to gastroenterologists" who perform the procedure, said Texas gastroenterologist Havemann, adding that the guidelines are reasonable and evidence-based.

"The recommendation to not screen female GERD patients is compelling," Havemann said.

The authors of the ACP guidelines point out that the risk of esophageal cancer in women with GERD is similar to that of breast cancer among men, a group that is not recommended to receive breast cancer screening. "That's something I will talk about with a woman about why not to use screening upper endoscopy," Havemann said.

Havemann thinks that upper endoscopies are particularly overused in young people who could get relief from prescription medication.

In addition, it is not recommended to do a follow-up endoscopy if the first one shows no signs of cancer or Barrett esophagus, a condition in which the esophagus is damaged and which can also increase the risk of developing esophageal cancer. However some of these patients do receive repeat endoscopies, Havemann said.

However, although not mentioned in the current guidelines, patients who don't take PPIs because of concerns about long-term side effects may need endoscopies to monitor potential GERD complications, he added.

Although upper endoscopies are low-risk, leading to complications like bleeding and tissue tearing in only about one in 1,000 to one in 10,000 cases, there are other reasons to avoid the procedure, Shaheen said.

An upper endoscopy costs $800, and even insured patients may have to pay a substantial share of this cost, the authors of the ACP guidelines wrote.

"It can be incredibly wasteful and expensive," Shaheen said. "While we don't want to deny anybody needed services, if we see areas with the potential to limit expense and improve
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