Heartburn and acid reflux are relatively common in Pennsylvania patients, and many times they are a sign of GERD, a condition where stomach contents leak backward from the stomach to the esophagus. In some cases this can lead to Barret's Esophagus, which involves erosion of the lining, and in some cases it can increase the risk of esophageal cancer. But recently the American College of Physicians urged doctors to hold off on using endoscopy as a diagnostic tool for many patients because they feel that their risk of these complications does not justify the cost. The determination could lead to stringent requirements which may inhibit doctors from using the tool for some patients who need it, and may even lead to accusations of medical malpractice.

The recommendation to limit the use of endoscopy to those with more severe symptoms is made with a claim that it will both reduce costs and improve patient care. If the recommendations are followed endoscopy would only be used in more serious instances such as if heartburn is accompanied by weight loss, vomiting, anemia, or other alarming symptoms. When patients are treated for GERD with maximal therapy for 4-8 weeks and their symptoms persist, when there is a history of erosion of the esophagus, and for esophageal cancer screening for those over 50.

While scaling back might look like a good idea on paper, these recommendations could fuel insurance companies to deny coverage for patients that might benefit from an endoscopy who may not fall into one of the approved groups. One large insurer pointed out that close to 40% of endoscopies do not improve the health of the patients.

While it may be true that endoscopy and other diagnostic tools might be overused, each patient is different and it is difficult to tell which person will be an exception that needs a particular level of care, despite not fitting the typical profile.

Source: MedPage Today, "Endoscopy Overused in GERD, Internist Group Says," Crystal Phend, Dec. 3, 2012