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Gastroenterology. 2018 May;154(7):1993-2003. doi: 10.1053/j.gastro.2017.12.044. Epub 2018 Feb 15.

Less Is More: A Minimalist Approach to Endoscopy.

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University of North Carolina at Chapel Hill, Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Chapel Hill, North Carolina. Electronic address:
Division of Gastroenterology and Hepatology, Oregon Health and Sciences University, Portland, Oregon.
Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands.


A substantial literature documents inappropriate usage of gastrointestinal endoscopy in a variety of clinical settings. Overusage of endoscopy appears to be common, and 30% or more of procedures performed in some clinical settings have questionable indications. The potential reasons for overuse of endoscopy are multiple, and include cancer phobia, fear of medical malpractice litigation, profit motive, the investigation of "incidentalomas" found on other imaging, and underappreciation of the delayed harms of endoscopy, among other reasons. Clinical guidelines, which should limit overuse of endoscopy, may instead serve to promote it, if authors opt to be "conservative," recommending endoscopy in situations of unclear utility. Several strategies may decrease overuse of endoscopy, including careful attention to risk stratification when choosing patients to screen, adherence to guidelines for surveillance intervals for colonoscopy, the use of quality indicators to identify outliers in endoscopy utilization, and education on appropriate indications and the risks of overuse at the medical student, residency, and fellowship levels.


Barrett’s Esophagus; Colorectal Cancer Screening; Gastrointestinal Endoscopy; Utilization

[Indexed for MEDLINE]

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