The prescription of esophagogastroduodenoscopy (EGD) has been steadily increasing over the years. However, some indications may be excessive, highlighting the need to rationalize its use. The EPAGE criteria, developed by a panel of European experts, provide a validated tool for assessing the appropriateness of indications for upper gastrointestinal endoscopy.

The aim of this study was to evaluate these criteria in validating indications for upper gastrointestinal endoscopy and to examine the correlation between the appropriateness of the indication and endoscopic findings.

We conducted a retrospective descriptive study including all patients who underwent EGD in the digestive endoscopy unit of our Department : Hepato-Gastroenterology and Proctology “Medicine B” at Ibn Sina Hospital, Rabat between January 2023 and October 2025.

The appropriateness of the EGD indication was assessed according to the EPAGE criteria and classified as necessary and appropriate, appropriate, uncertain, inappropriate, or not applicable, using the software available at video abstract.

EGDs with indications not covered by the EPAGE criteria were excluded from the analysis.

A total of 410 upper gastrointestinal endoscopies were performed during the study period, of which 88 (21.4%) were excluded. Overall, 352 patients were included, with a mean age of 48.6 years (16–92 years). There was a marked female predominance, with a F/M ratio of 1.6.

The most frequent indications for EGD were: persistent epigastric pain despite adequate medical therapy in 106 patients (32.9%),upper gastrointestinal bleeding in 80 patients (24.8%), iron-deficiency anemia in 52 patients (16.14%).

According to the EPAGE criteria, the indication was classified as necessary and appropriate in 152 patients (47.2%), appropriate in 73 patients (22.6%), inappropriate in 33 patients (10.2%), and uncertain in 64 patients (19.87%). In 21.46% of cases, the EPAGE criteria were not applicable.

A significant endoscopic lesion was identified in 165 patients (73.3%) when the indication was deemed necessary and appropriate/appropriate.

There was a statistically significant association between the appropriateness of the indication and the presence of significant endoscopic findings (p < 0.001).

When the indication was considered inappropriate/uncertain, a significant lesion was detected in 17.5% of cases, including 9 cases of gastric or duodenal ulcers and 4 cases of neoplastic lesions.

In our study, 73% of upper gastrointestinal endoscopies were judged to have an appropriate indication. However, 17.5% of EGDs performed for inappropriate or uncertain indications revealed significant findings. These results underscore the need to update and refine the EPAGE criteria to better guide clinical decision-making.