Gastrointestinal endoscopy in the pregnant woman

Table 3 Indications for esophagogastroduodenoscopy during pregnancy

Strong indications1
	Dysphagia > 1-2 wk, especially with diminished intake or weight loss
	Odynophagia > 1-2 wk
	Gross gastrointestinal hemorrhage with hematemesis and/or melena, especially if patient becomes hypotensive, requires blood products, or has a significant acute hemoglobin decline
	GI hemorrhage with strong clinical suspicion of varices
	Suggestion of malignancy on radiologic imaging studies (e.g., MRI)
	Possible gastric outlet obstruction (e.g., from peptic ulcer disease)
	Endoscopic therapy for continued UGI bleeding
	Balloon dilatation of symptomatic UGI stricture (e.g., endoscopic therapy for reflux stricture)
Moderate indications
	Recurrent nausea and emesis (including possible hyperemesis gravidarum) if patient > 16-18 wk pregnant and concern exists for peptic ulcer disease with inadequate patient response to > 2 wk of conservative therapy, including PPI
	Strong need for endoscopic placement of enteric tube (e.g., for hyperemesis or severe, prolonged, acute pancreatitis)
	Nausea and emesis after UGI surgery (including bariatric surgery) with concern for postsurgical stricture
Weak indications
	Hyperemesis gravidarum during first trimester
	Self-limited nausea, emesis or abdominal pain
	GERD symptoms, excluding dysphagia not responsive to empiric PPI therapy
	Routine endoscopic surveillance for higher risk patients (e.g., EGD for personal history of familial polyposis coli)-can be deferred until postpartum
	Iron deficiency anemia-should generally be deferred until postpartum

¹These recommendations incorporate the American Society for Gastrointestinal Endoscopy (ASGE) guidelines[4] as recommendations 1-4, and 7, but the current report adds recommendations 5, 6 and 8 that were not addressed in the ASGE guidelines. MRI: Magnetic resonance imaging; UGI: Upper gastrointestinal; GERD: Gastroesophageal reflux disease; EGD: Esophagogastroduodenoscopy; PPI: Proton pump inhibitor.