OGD is one of the most commonly requested gastro procedures in the NHS.

It is:

Very useful
But invasive
Limited capacity

So the key skill is knowing:

Who needs urgent scope,
who needs routine scope,
and who doesn’t need one at all.

This guide focuses on safe, practical decision-making for junior doctors.

✅ First principle

Before requesting OGD, ask:

Will the result change management?

If not → don’t scope.

OGD is not a reassurance test.

🚨 URGENT / SAME-DAY OGD (on-call or inpatient)

These patients need immediate or early inpatient endoscopy.

Do not delay.

🔴 Upper GI bleeding (most common indication)

Haematemesis
Coffee-ground vomit
Melaena
Hb drop with suspected GI source

Because:

Needs diagnosis + therapy (clips/banding/injection)

👉 Refer urgently

This is the bread-and-butter emergency for OGD.

🔴 Suspected variceal bleed

Known cirrhosis + bleeding

Because:

Needs banding
High mortality

👉 Urgent scope

Never sit on these patients.

🔴 Suspected cholangitis needing ERCP (not OGD but related pathway)

Fever + jaundice + obstruction

👉 urgent endoscopic intervention

🔴 Food bolus obstruction

Can’t swallow saliva
Acute dysphagia

Because:

Risk of aspiration
Needs removal

👉 urgent endoscopy

🔴 Caustic ingestion / severe oesophageal injury

Needs early assessment.

⚠️ INPATIENT / EARLY OGD (within admission or 2–4 weeks)

Not crashing, but shouldn’t wait months.

🟡 Dysphagia (very important)

Any new dysphagia:

Solids or liquids
Progressive

Think cancer until proven otherwise.

👉 2-week wait / urgent OGD

Never label as reflux without scope.

🟡 Iron deficiency anaemia (IDA)

Especially:

Males
Postmenopausal women

Because:

Need to exclude upper GI malignancy/ulcer

👉 OGD ± colonoscopy

Very common real-life referral.

🟡 Weight loss + upper GI symptoms

Red flag.

🟡 Persistent vomiting

To exclude obstruction/ulcer.

🟡 Suspected gastric outlet obstruction

Early satiety, vomiting, distension.

🟡 Suspected malignancy

Anaemia
Dyspepsia with red flags
Palpable mass

👉 urgent pathway

✅ ROUTINE / OUTPATIENT OGD

Appropriate but not urgent.

🟢 Persistent dyspepsia despite treatment

After:

PPI trial
H. pylori testing

If still symptomatic → routine OGD reasonable

🟢 Chronic reflux with alarm features or poor response

🟢 Surveillance

Barrett’s oesophagus
Varices
Previous ulcers
Post-cancer follow-up

Planned scopes, not urgent.

❌ Usually NO OGD needed

Very common over-referrals.

❌ Simple dyspepsia (<55, no red flags)

Treat first:

PPI
H. pylori

No immediate scope needed

❌ Known reflux responding to treatment

❌ Mild gastritis symptoms only

❌ “Just to check everything is normal”

Not a reason

✅ Red flags that should trigger urgent thinking

If ANY present → escalate urgency:

Dysphagia
Weight loss
Anaemia
GI bleeding
Persistent vomiting
Age >55 with new symptoms
Family history cancer
Palpable mass

These are cancer-pathway symptoms until proven otherwise.

✅ Simple ward decision rule

When thinking about OGD:

Ask:

Is there bleeding? → urgent
Is there obstruction/dysphagia? → urgent
Is there anaemia/weight loss/red flag? → early
Just dyspepsia? → treat first

This covers 90% of cases.

✅ How to make a good OGD referral (important)

Include:

Indication clearly
Hb
Observations
Anticoagulation status
Comorbidities
Stability

Instead of:
❌ “Please scope”

Say:
✔ “Melaena, Hb dropped 40, stable after fluids – query UGIB”

Clear referrals get faster scopes.

❌ Common junior mistakes

Scoping simple dyspepsia
Missing dysphagia red flag
Not referring UGIB early
Forgetting IDA needs scope
Using OGD for reassurance only

Remember:
OGD is for diagnosis that changes management.

✅ Take-home concept

Scope bleeding and red flags urgently.
Scope persistent or concerning symptoms routinely.
Don’t scope simple dyspepsia.