Upper GI Endoscopy (EGD)

What it does

Upper GI Endoscopy reads a recorded oesophagogastroduodenoscopy, as video or as the still images saved during the examination. Missed early gastric cancer and Barrett's neoplasia are the main failures of EGD, and both are tied to an incomplete examination; the read checks the examination and the mucosa together.

The result lists which standard stations were seen and photographed, from the oesophagus and Z-line through the cardia, fundus, body, angulus, antrum and pylorus to the duodenum, and alerts on missing ones. In the distal oesophagus it detects erosive oesophagitis and assigns the Los Angeles grade. A Barrett's segment is measured as a Prague C&M estimate, with areas suspicious for dysplasia or early cancer marked for targeted biopsy. In the stomach, suspected early gastric cancer and adenomas are detected and delineated.

Intended use

Decision support after the examination: a documented completeness check for quality audit, a second look at the oesophagogastric junction and stomach, and structured findings for the report. Lesion flags point to the frames that matter for biopsy planning.

Who it is for

Gastroenterologists, upper-GI surgeons, endoscopy trainees and units auditing photo-documentation. Developers use the run to add structured EGD findings and quality indicators to an endoscopy reporting system.

Accepted input

• Video: MP4, MOV or MKV, or DICOM Video Endoscopic Image; a typical EGD of 5–15 minutes.
• Still sets: the photo-documentation of the examination as JPEG/PNG or DICOM VL Endoscopic Image.
• Light modes: white light and image-enhanced modes (NBI, BLI, LCI, i-scan), detected per frame.

Requirements

Requirement	Why
Retroflexed view of the cardia and fundus	Completeness and the gastric read need the retroflexion station
Insufflated, washed oesophagus	Mucus, bubbles and collapsed lumen hide erosions and Barrett's tongues
Clear view of the Z-line and the top of the gastric folds	Separates short-segment Barrett's from an irregular Z-line and anchors Prague C&M
Close views of suspicious areas	Neoplasia flags need near views, ideally with image enhancement

Optional context

Indication (dyspepsia, reflux, Barrett's surveillance, bleeding), known Barrett's length and prior histology can be passed in clinical_context.

The result

Section	Content
Examination completeness	Stations seen and photographed, with a missing-station alert
Oesophagitis (LA grade)	Erosive oesophagitis present or absent and Los Angeles grade A–D
Barrett's oesophagus	Prague C&M estimate and neoplasia flags for targeted biopsy
Gastric neoplasia	Detected and delineated suspected early gastric cancer or adenoma, with Paris type
Draft report	Opt-in (options.report): an English narrative that interprets the result for the reader (findings, impression, limitations); every number is checked against the findings

Standards

• Terminology: WEO Minimal Standard Terminology (MST 3.0).
• Quality: ESGE upper-GI performance measures for photo-documentation; the systematic screening protocol for the stomach.
• Grading: Los Angeles classification of oesophagitis; Prague C&M criteria and the Seattle biopsy protocol for Barrett's; Paris classification of superficial lesions.
• DICOM and FHIR: key frames as VL Endoscopic Image, KOS key-frame lists, lesion masks as Segmentation, grades and estimates in SR TID 1500; FHIR R4 Procedure and DiagnosticReport.

Barrett's measurement

Prague C is the circumferential extent and M the maximum extent of columnar mucosa above the gastro-oesophageal junction, in centimetres. From video, both are estimated without a calibrated scale.