Endoscopy in the evaluation of patients with upper gastrointestinal symptoms: indications, expectations, and interpretation.

Upper gastrointestinal endoscopy is the most sensitive diagnostic test in patients with upper gastrointestinal symptoms. Endoscopy performed by trained examiners, however, still misses lesions. Single-contrast upper gastrointestinal x-ray adds little new information to a complete endoscopic examination by a trained endoscopist. With the availability of "skinny" endoscopes as well as the ability to obtain directed cytology and biopsy via the endoscope, a clinician may well choose upper gastrointestinal endoscopy as the first and possible only diagnostic test in the evaluation of upper gastrointestinal symptoms. The cost of the procedure, however, and the limited availability of trained endoscopists may inhibit the widespread use of this procedure as the initial diagnostic test.