In a patient with dysphagia, which scenario is an indication for urgent endoscopy?

• A. Chronic mild dysphagia
• B. Suspected GI bleed
• C. Routine endoscopy for GERD
• D. Intermittent heartburn

Answer: (B)

Urgent endoscopy is reserved for red-flag features where a sudden, potentially life-threatening issue could be at play. Suspected upper GI bleed is such a signal: signs of bleeding or anemia mean there could be an acute source like a peptic ulcer, esophageal varices, or a mucosal tear, and endoscopy can both diagnose and provide immediate treatment to stop the bleed. That need for rapid diagnosis and possible therapeutic intervention makes it the scenario that requires urgent evaluation.

Chronic mild dysphagia without alarming features is usually evaluated electively because it often reflects non-emergent causes such as mild motility issues or non-progressive obstruction. Routine endoscopy for GERD and intermittent heartburn are likewise elective, used for evaluating chronic symptoms or mucosal changes over time rather than addressing an acute problem.