Medical Global Academy

August 12, 2026

Doctor reviewing clinical indications for diagnostic vs therapeutic endoscopy
Learning blogs

Diagnostic vs Therapeutic Endoscopy: Indications, Skill Requirements and Referral Thresholds

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Quick Answer Diagnostic endoscopy uses the endoscope to visualise the gastrointestinal tract and identify pathology — its output is a finding and a report. Therapeutic endoscopy uses the same instrument to treat what has been found — its output is an intervention. The distinction matters clinically because therapeutic procedures require additional skills, equipment, dedicated time, specialist backup, and in many cases a higher-acuity facility. Most referrals from general practice and general medicine are for diagnostic endoscopy; the decision to escalate to therapeutic endoscopy is usually made after the diagnostic findings are known. Every doctor who manages GI patients refers for endoscopy. Not every doctor who refers understands precisely what they are requesting — or when diagnostic endoscopy alone is insufficient and therapeutic capability becomes the clinical requirement. That gap matters in practice. A referral that should specify urgent therapeutic endoscopy capability such as an acute upper GI bleed is not the same referral as a routine diagnostic OGD for dyspepsia. Sending the wrong referral to the wrong setting delays definitive management. This article is for general physicians, surgeons, and family medicine doctors who refer GI patients for endoscopy but want a clearer clinical framework for the referral decision. Doctors who want to extend their own endoscopy knowledge beyond the referral level can explore MGA’s Fellowship in GI Endoscopy. 2 types Diagnostic · Therapeutic Key skill Knowing which referral to make Overlap Many procedures start diagnostic, turn therapeutic What this article covers Defining diagnostic endoscopy: what it is, what it does Defining therapeutic endoscopy: what distinguishes it Upper GI: diagnostic indications vs therapeutic triggers Lower GI: diagnostic indications vs therapeutic triggers The overlap problem — procedures that start diagnostic and become therapeutic Referral thresholds: what to specify when you refer Frequently asked questions Defining diagnostic endoscopy: what it is, what it does Diagnostic endoscopy is the use of a flexible endoscope to directly visualise a segment of the gastrointestinal tract. Its purpose is to find, characterise, and document pathology. The endoscopist looks, biopsies if indicated, and reports findings. No therapeutic intervention is performed during the procedure itself. The output of a diagnostic endoscopy is information: the mucosal appearance at sites examined, the presence and characteristics of lesions, and the correlation of visual findings with the clinical question that prompted the referral. That information then guides the management decision — which may include a separate therapeutic procedure, medical treatment, surveillance, or discharge. Diagnostic endoscopy encompasses upper GI endoscopy (OGD) for oesophageal, gastric, and duodenal evaluation, and colonoscopy or flexible sigmoidoscopy for colonic and terminal ileal evaluation. Capsule endoscopy used for small bowel evaluation is diagnostic only. Defining therapeutic endoscopy: what distinguishes it Therapeutic endoscopy — also called interventional endoscopy or operative endoscopy — uses the same endoscopic access to treat pathology rather than only identify it. An instrument passed through the working channel of the endoscope performs the therapeutic action while the endoscopist maintains visual control. What distinguishes therapeutic from diagnostic endoscopy in practical terms is not just the procedure performed — it is the requirement set that surrounds the procedure. Diagnostic endoscopy requires Endoscopist with scoping competence Standard endoscopy unit setup Conscious sedation or no sedation Basic monitoring Biopsy forceps if sampling needed Therapeutic endoscopy additionally requires Endoscopist trained in specific therapeutic technique Additional accessories — clips, snares, balloons, cautery Higher-acuity monitoring and backup Surgical backup availability for complications Often: anaesthesia support for deeper sedation This distinction has direct relevance to referral — a facility capable of diagnostic endoscopy is not automatically capable of therapeutic endoscopy. Referring an acute upper GI bleed to a unit without haemostatic capability is a clinical mismatch that delays treatment. Upper GI endoscopy: diagnostic indications vs therapeutic triggers When diagnostic OGD is appropriate Indication What you are looking for Priority Dyspepsia with alarm symptoms Malignancy, ulcer, Barrett’s oesophagus Urgent — within 2 weeks Unexplained dysphagia Malignancy, stricture, motility disorder Urgent Unexplained iron-deficiency anaemia Upper GI source of chronic blood loss Elective to semi-urgent Suspected peptic ulcer disease Active ulcer, H. pylori status, healing Elective to semi-urgent Persistent vomiting without explanation Gastric outlet obstruction, mucosal pathology Semi-urgent Surveillance — Barrett’s oesophagus Dysplasia surveillance Elective (interval-based) When the therapeutic threshold is triggered in upper GI Clinical Scenario Therapeutic Procedure Required Facility Requirement Active upper GI haemorrhage Endoscopic haemostasis — adrenaline injection, thermal coagulation, haemostatic clips Therapeutic unit with anaesthesia and surgical backup Peptic ulcer with high-risk appearance Haemostatic therapy (dual modality preferred) Therapeutic unit — urgent Oesophageal or gastric varices with active bleeding Band ligation (oesophageal), injection sclerotherapy (gastric) Specialist GI unit with variceal expertise Oesophageal stricture causing dysphagia Balloon or bougie dilation Therapeutic endoscopy unit Biliary obstruction (suspected CBD stone, cholangitis) ERCP with sphincterotomy and stone extraction ERCP-capable centre — specialist procedure Lower GI endoscopy: diagnostic indications vs therapeutic triggers When diagnostic colonoscopy is appropriate Indication What you are looking for Priority Rectal bleeding (no obvious anorectal source) Colorectal malignancy, polyps, IBD, angiodysplasia Urgent to semi-urgent by age and features Altered bowel habit, unexplained Colorectal malignancy, IBD Semi-urgent if alarm features present Unexplained iron-deficiency anaemia Right-sided colonic malignancy, angiodysplasia Semi-urgent Positive faecal occult blood test Adenomatous polyp, early colorectal malignancy Within 4–6 weeks Known or suspected IBD Disease extent, activity, biopsy for histology Elective to semi-urgent Surveillance — previous polyp or malignancy Recurrence, new polyps Elective (interval-based) When the therapeutic threshold is triggered in lower GI Clinical Scenario Therapeutic Procedure Required Key Consideration Colonic polyp identified on diagnostic colonoscopy Snare polypectomy or EMR depending on polyp size and morphology May be performed in same sitting or listed for separate therapeutic session Lower GI haemorrhage from angiodysplasia Thermal coagulation, haemostatic clips, injection Requires therapeutic capability — urgent referral Colonic stricture Balloon dilation or stenting Specialist therapeutic endoscopy unit The overlap problem: procedures that start diagnostic and become therapeutic One of the most practically important aspects of this distinction is that many procedures that begin as diagnostic become therapeutic intraoperatively. Example 1: A patient referred for diagnostic OGD for dyspepsia is found on scoping to have a gastric

Doctor performing a procedure representing a fellowship in GI endoscopy
Learning blogs

Fellowship in GI Endoscopy: Eligibility, Curriculum and Clinical Scope in India

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Quick Answer A Fellowship in GI Endoscopy is a structured, one-year training program for qualified doctors who want to build focused competence in upper and lower gastrointestinal endoscopy — both diagnostic and therapeutic. It is not equivalent to a DM Gastroenterology degree and does not substitute for it. What it does provide is systematic endoscopic training, a CPD-accredited credential, and clinical knowledge of GI procedures that most MBBS and MD curricula do not cover in depth. Eligibility at MGA requires a minimum of four years of post-qualification experience. GI endoscopy is no longer a subspecialty procedure confined to tertiary hospitals. Upper GI endoscopy and colonoscopy are performed across a wide range of settings in India — district hospitals, standalone endoscopy units, and private gastroenterology practices. The demand for doctors who can both perform and interpret these procedures competently is rising faster than formal DM Gastroenterology training produces specialists. A Fellowship in GI Endoscopy is one structured response to that gap. This article explains what the fellowship covers, who can apply, what procedural competencies it addresses, and where it sits relative to a full gastroenterology degree — so you can evaluate it accurately before making a decision. MGA’s Fellowship in GI Endoscopy course page has detailed program information and the application process. This article provides the clinical and career context around it. 1 year Program duration 4 yr min Post-qualification experience required CPD Accredited credential What this article covers What a GI endoscopy fellowship is — and what it is not Who is eligible to apply Core curriculum areas: what you will study Procedural competencies addressed in the program Fellowship vs DM Gastroenterology: an honest comparison Where this fellowship fits in a GI career Frequently asked questions What a GI endoscopy fellowship is — and what it is not A Fellowship in GI Endoscopy is a focused, specialty-specific training program structured around gastrointestinal endoscopy as a clinical discipline — covering the anatomy, pathology, procedural skills, and clinical decision-making involved in upper and lower GI endoscopic work. MGA’s fellowship is CPD accredited and carries international recognition through applicable UK accrediting bodies. It runs for one year, using evening live classes timetabled after OPD hours so doctors can continue practising while completing the program. What it is not: It is not an MD, MS, or DM degree. It does not confer the title of Gastroenterologist. It does not satisfy government promotion criteria that require degree-level qualifications. Doctors who want a DM Gastroenterology should pursue the standard NEET-PG and superspeciality pathway. What a fellowship does provide is systematic clinical knowledge of GI endoscopy — the indications, contraindications, procedural techniques, complication management, and interpretation skills — that general MBBS and MD training does not cover in depth, delivered in a format that working doctors can complete without pausing their practice. Who is eligible to apply MGA’s Fellowship programs require a minimum of four years of post-qualification clinical experience. For the GI Endoscopy fellowship specifically, the program is designed for doctors who are already doing or intending GI-related work — not for fresh graduates. Qualification Relevant Background MBBS General practitioners with GI patient caseload, doctors in settings where basic endoscopy is performed MD General Medicine Physicians managing upper GI bleeding, dyspepsia, peptic ulcer disease, and liver disease who want procedural training to complement clinical management MS General Surgery Surgeons performing or assisting GI procedures who want formal endoscopic training DNB (relevant specialties) DNB-qualified doctors in gastroenterology, surgery, or medicine with the required experience The minimum four-year experience requirement is not a formality. GI endoscopy training builds on clinical foundation — doctors who have managed GI patients, recognised endoscopic indications, and understood the referral thresholds in practice gain substantially more from the fellowship curriculum than those encountering this material fresh. Check your eligibility for the Fellowship in GI Endoscopy CPD accredited · One year · Evening classes after OPD · Eligible doctors only View Course & Apply Core curriculum areas: what you will study A GI endoscopy fellowship curriculum is built around three layers of knowledge: the anatomical and pathological foundation, the procedural and technical layer, and the clinical decision-making layer. Together these allow a doctor to move from identifying that an endoscopy is indicated to performing it, interpreting what they find, and managing what they encounter. GI anatomy and pathophysiology The curriculum covers the anatomy of the upper and lower gastrointestinal tract in the context of endoscopic access — the landmarks, the anatomical variants that matter during scoping, and the physiological basis of the conditions most commonly identified on endoscopy. This includes oesophageal anatomy and motility, gastroduodenal anatomy and mucosal changes, and colonic anatomy relevant to colonoscopy technique and polyp detection. Upper GI endoscopy — principles and indications Upper GI endoscopy (OGD) is covered in detail, including its diagnostic indications — dyspepsia with alarm symptoms, suspected peptic ulcer disease, upper GI bleeding, surveillance in Barrett’s oesophagus, evaluation of dysphagia — and contraindications. Interpretation of mucosal findings including erythema, erosions, ulcers, polyps, malignant-appearing lesions, and varices is a core curriculum component. Colonoscopy — principles and indications Colonoscopy training covers the indications for lower GI endoscopy: investigation of rectal bleeding, altered bowel habit, iron-deficiency anaemia, polyp surveillance, inflammatory bowel disease assessment, and colorectal cancer screening. Technique principles including patient preparation, scope advancement, cecal intubation, mucosal inspection, and withdrawal technique are addressed alongside clinical interpretation of colonoscopic findings. Therapeutic endoscopy — principles The curriculum addresses the therapeutic dimensions of GI endoscopy — procedures performed through the endoscope to treat conditions identified on diagnostic scoping. This includes haemostasis for upper GI bleeding, polypectomy, mucosal biopsy technique, dilation of strictures, and the principles of ERCP. The level of therapeutic training in a one-year fellowship is principled and foundational rather than full independent competence in all interventions. Complication recognition and management Endoscopic procedures carry recognised complication profiles — perforation, bleeding, cardiopulmonary events related to sedation, and aspiration. The curriculum covers the recognition, immediate management, and referral pathways for complications of upper and lower GI endoscopy. Patient safety, consent, and sedation principles

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