Currently, preventive medicine has become one of the main pillars of healthcare systems. Given the prevalence of colorectal cancer in several countries, screening colonoscopy has become a widely defined strategy. With the progressive systematization of this examination, there has also been an increase in patient demand for simultaneous upper digestive endoscopy (EGD), that is, during a scheduled colonoscopy. This scenario raises discussions about the role of EGD in primary screening and the appropriateness of its routine indication in this context. Therefore, this study aimed to evaluate the performance of opportunistic EGD diagnosis during a scheduled colonoscopy and the impact of its findings on patient treatment and follow-up. The proposal was to analyze not only the proportion of gastrointestinal tract abnormalities that resulted in clinical repercussions, but also the rate of early-diagnosed esophagogastric preneoplastic lesions and their implications as an initial strategy for neoplasia screening in a service with intermediate gastric cancer risk.

This single-center, retrospective, descriptive, cross-sectional study was based on the analysis of electronic medical records from the “MV PEP SOUL” and “Philips Radiology Information” systems of asymptomatic patients from a gastrointestinal standpoint who underwent opportunistic endoscopies during scheduled colonoscopies at a high-complexity private hospital between March 2023 and March 2025. EGD was considered to have clinical impact when the diagnosis altered patient management, leading to the need for immediate therapy, outpatient follow-up, or continued surveillance. Quantitative variables were represented by minimum, maximum, mean, standard deviation (SD), median, first and third quartiles (Q1 and Q3). Analyses were performed using RStudio version 2025.05.0 with the R programming language version 4.5.0.

A total of 421 patients were analyzed, 63.9% female, with a mean age of 58.4 years. Only 27 patients showed no macroscopic alterations on examination, with 5 having histological corroboration of normality. Clinical-impact findings, those requiring pharmacological treatment or endoscopic/ambulatory follow-up, were present in 44.7% of examinations. Gastritis was observed in 69.6% of patients, with 24.2% associated with Helicobacter pylori. Pre-malignant gastric lesions were identified, including 10.7% intestinal metaplasia, 6.4% atrophy, and two cases of low-grade dysplasia. One diagnosis of Lauren mixed-type gastric carcinoma and one of marginal zone lymphoma of the MALT B-cell type were made. Six gastric ulcers and fourteen subepithelial lesions were also found. One hundred and forty gastric polyps were identified, of which 66% were fundic glands, 19% hyperplastic, 12.86% inflammatory, and 0.71% adenomas with low-grade dysplasia. Among the predominant alterations of the duodenal mucosa, 6.2% were bulboduodenitis, 2.4% bulbar cicatricial deformity, 0.2% duodenal ulcer, 1.2% subepithelial lesions, and 1.2% duodenal polyps, including two tubular adenomas with low-grade dysplasia. A tubular adenoma with low-grade dysplasia was also identified in the minor duodenal papilla. Regarding esophageal alterations, the most prevalent was esophagitis (31.8%), with 6.88% grade B, 1.88% grade C, and 0.24% grade D, findings representative of gastroesophageal reflux disease (GERD) according to the Lyon Consensus. Barrett's esophagus was also confirmed in 0.7% of the sample. Hiatal hernias were also observed in 6.9%, papillomas in 1.7%, subepithelial lesions in 0.2%, and esophageal candidiasis in 0.7%.

Despite being asymptomatic, most patients presented endoscopic and histological alterations. As corroborated in the literature, a considerable number of patients with gastrointestinal diseases are still not diagnosed because they do not present symptoms for which endoscopy is considered necessary. The findings in this analysis culminated in a change in management in almost half of the patients, including eradication therapy for Helicobacter pylori, treatment of GERD and peptic ulcers, management of malignant lesions, and the establishment of a surveillance protocol for esophagogastric pre-neoplastic lesions. Given the evidence in the literature of a substantial rate of pre-malignant lesions in asymptomatic individuals, opportunistic endoscopy would be a potential screening alternative, although further studies are needed to support its role in screening.