Upper GI Endoscopy and the Disappearing Barium Study III

Comparative Costs of Upper GI series and Endoscopy

A complete upper GI X-ray study with barium (esophagus, stomach, with “follow through” including upper intestine) costs $272; Medicare allows $155 in a relatively high cost region (Philadelphia and suburban area).

An EGD or upper GI endoscopy is anywhere from three to six times as costly. This site quotes an average $1988, another URL quotes $1065, with almost half these charges including cost of anesthesia which is used in over 98% of patients. However, a breakdown of charges by geographical areas and including use of hospital endoscopy suites is difficult to obtain.

The Big Picture

Many obvious questions arise in the area of invasive imaging of the gastrointestinal tract when non-invasive X-ray studies are available, cheaper, and in 95% of cases superior, and without risk. The problem of audacious overuse of upper EGD is not limited to the U.S., since in Europe upper endoscopy is just as prevalent. Certainly upper GI endoscopy is a crucial method in the diagnosis of some gastrointestinal conditions, but in view of the problem of complications, even death, should it be an almost routine procedure in imaging the upper GI tract, when the much less costly upper GI study with barium, a procedure virtually without risk or complication, is available in every radiology department?

This is a question to be asked every physician who orders EGD and every insurer or HMO who pays for it. Certainly, I do not argue the need for EGD in cases of foreign body, upper GI bleeding, or the presence of ominous findings on the upper GI study. But if the upper GI were done first, 9.5 million or more of 10 million yearly EGD’s could be avoided with a savings to the health care system of $12 billion to $18 billion, not to mention tens of thousands of complications, and the saving of several hundred lives.

If there is any question about risk and complications of EGD, if you are asked to undergo the procedure, make sure you ask if an X-ray study could be substituted. Also read the informed consent which reveals all.

Why EGD has virtually replaced the upper GI barium in imaging patients with gastrointestinal complaints is a complicated question with economic overtones and a “politically correct” consensus driven by specialty groups. In the meantime, perhaps we can liken the inappropriate use of invasive studies for routine problems as a form of diagnostic seduction. Better yet, how about technological exuberance or invasive imperialism?

Martin F. Sturman, MD, FACP


3 Responses to “Upper GI Endoscopy and the Disappearing Barium Study III”

  1. Tiamo says:

    Well written. I had an EGD scheduled, which is covered by our provincial insurance. However, I question the need for EGD without doing enough diagnosis. We seem to be living in an automated technology age, the first thing most doctors will throw at ya are more and more technical tests. What happened to logical thinking?

  2. Much appreciated, Tiamo. Your comments hit the nail on the head. I have previously written about this problem of unnecessary, expensive, and dangerous diagnostic testing. See my newsletter about EGD http://www.easydiagnosis.com/secondopinions/newsletter23.html Unfortunately I left out the problem of radiologists who now are poorly trained-for lack of experience-in doing upper and lower GI studies.

  3. Paul Richard says:

    Very informative, the big picture of this blog is the area of invasive imaging of the gastrointestinal. But if we take a look on the side effects of GI Endoscopy Procedure then they are only temporary such as mild throat with irritation and rarely aspiration pneumonia. Good Luck!

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