Do not prescribe endoscopic examination when low-waste, less invasive alternatives endorsed by evidence-based clinical guidelines are available.

Type of practice

Other tests

Topic Area


Less invasive tests approved by regulatory agencies as alternatives to gastrointestinal endoscopy are: fecal calprotectin in monitoring patients with inflammatory bowel diseases and in chronic diarrhea; C-13 urea breath test and stool antigen test in diagnosis of Helicobacter Pylori infection; fecal immunohistochemical testing for colorectal cancer screening; platelet count and elastography for screening of esophageal varices in cirrhosis and in monitoring liver disease. These alternatives can reduce risk of harm to patients and the environmental impact of endoscopic procedures. Patients and citizens have to be informed and involved in these decisions.


1. Jukic A, Bakiri L, Wagner EF et al. Calprotectin: from biomarker to biological function. Gut 2021; 70: 1978–1988.
2. Gisbert JP, Alcedo J, Amador J et al. V Spanish Consensus Conference on Helicobacter pylori infection treatment. Gastroenterol Hepatol 2021
3. De Franchis R. Baveno VI Faculty. Expanding consensus in portal hypertension: Report of the Baveno VI Consensus Workshop: Stratifying risk and individualizing care for portal hypertension. J Hepatol 2015; 63: 743–752.
4. Bortoluzzi F, Sorge A, Vassallo R et al. Sustainability in gastroenterology and digestive endoscopy: position paper from the Italian Association of hospital gastroenterologists and digestive endoscopists (AIGO). Dig Liv Dis 2022; 54: 1623-1629



Attention. Please note that these items are provided only for information and are not intended as a substitute for consultation with a clinician. Patients with any specific questions about the items on this list or their individual situation should consult their clinician.