Most patients who undergo a combined upper and lower GI endoscopy think of it as one procedure. In clinical terms, it is two: an esophagogastroduodenoscopy examining the upper tract, followed by a colonoscopy examining the lower. The appeal of doing both in a single session is obvious. One preparation, one sedation event, and less time away from work or family. For health systems managing a specialist shortage that is projected to reach nearly 1,400 gastroenterologists by 2037, consolidating procedures wherever possible is moving from a convenience to a strategic necessity.
But combined GI endoscopy is rarely framed as a deliberate strategy for upper GI care. In most cases, it is driven by the colonoscopy. The patient is already there for colorectal cancer screening; the upper GI exam gets added on. That sequencing reflects something deeper: lower GI has decades of established quality infrastructure, with standardized metrics, outcome benchmarks, and a now-proven track record with AI-assisted detection. Upper GI less so.