U.S. GI Endoscopy Volumes: Biggest Change Is Increases in Upper Endoscopic Ultrasound

U.S. GI Endoscopy Volumes: Biggest Change Is Increases in Upper Endoscopic Ultrasound

Douglas K. Rex, MD, MASGE, reviewing Peery AF, et al. Gastroenterology 2021 Oct 19.

This article uses data from multiple sources to estimate gastrointestinal, liver, and pancreatic health care expenditures, ambulatory visits, and hospitalizations, as well as endoscopic procedural volumes. The estimated numbers of U.S. endoscopic procedures performed in 2019 are as follows:

  • Total endoscopic procedures: 22,162,641  
  • Colonoscopy: 13,837,748
  • Upper endoscopy: 7,459,419
  • Flexible sigmoidoscopy: 379,883
  • Upper endoscopic ultrasound: 290,655
  • ERCP: 177,508
  • Lower endoscopic ultrasound: 17,428

Over the past 20 years, general trends have included an overall decline in colonoscopy use in persons aged 75 years or older but a gradual increase in persons aged 50 to 74 years. The overall trend in upper endoscopy use has increased slightly in most age groups. Flexible sigmoidoscopy use decreased dramatically in the first decade of this century, with fairly stable low rates since then. ERCP volumes have been generally stable across all age groups. The biggest increases in volume were in upper endoscopic ultrasound (EUS) procedures, with volumes increasing more than 6-fold in some older age groups since 2002. On the other hand, lower EUS use has declined somewhat in the past decade.

Douglas K. Rex, MD, FASGE


These data indicate that colonoscopy and upper endoscopy remain the cornerstones of endoscopic practice, with the greatest opportunity for growth in upper EUS.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.


Peery AF, Crockett SD, Murphy CC, et al. Burden and cost of gastrointestinal, liver, and pancreatic diseases in the United States: update 2021. Gastroenterology 2021 Oct 19. (Epub ahead of print) (https://doi.org/10.1053/j.gastro.2021.10.017)

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