2015 AGA指南：上消化道活检在评估无可见黏膜损伤成人消化不良中的作用

Esophagogastroduodenoscopy (EGD) is commonly performed in the evaluation of patients with dyspepsia. The primary value of diagnostic EGD is the ability to obtain a tissue diagnosis of potentially symptomproducing lesions. In many cases, however, biopsies are obtained of mucosa without an obvious, anticipated pathologic or symptomatic correlate, such as either normal-appearing or nonspecifically abnormal tissue. Currently, there are no clinical standards or guidelines for the performance of such biopsies of normal-appearing mucosa. As a result, there is likely wide practice variation in whether or not such biopsies of normal-appearing mucosa are obtained. Additionally, how the results of such biopsies affect management is poorly understood. At the same time, although endoscopic biopsy itself is generally associated with a negligible rate of complications, it substantially increases the cost of the procedure by incurring a higher procedural fee and the attendant specimen processing and interpretation fees. The purpose of the current guideline is to establish evidence-based practicing standards for the performance of biopsies of normal-appearing mucosa in the upper gastrointestinal tract. This guideline focuses on adult patients (ie, older than 18 years of age) who are undergoing EGD with dyspepsia as the sole indication. Dyspepsia is defined according to the Rome III criteria, which include 1 or more of the following symptoms: bothersome postprandial fullness, early satiation, epigastric pain, and epigastric burning. In addition, this guideline assumes no prior treatment for Helicobacter pylori (HP) infection.