Introduction: Endoscopic ultrasound (EUS) and EUS-guided fine needle aspiration (EUS-FNA) have been used increasingly as a safe, accurate and diagnostic as well as therapeutic tool for a variety of gastrointestinal (GI) as well as non-GI conditions. In 2015, the ASGE and ACG released standard quality indicators for GI endoscopic procedures including EUS. Performing an EUS for an “appropriate” indication and having adequate photo documentation of structuresof interest were among the key indicators with different grades for the clarity of benefit. However, there was no mention for the utility of preprocedure esophagogastroduodenoscopy (EGD). Purpose: To see if an EGD prior to EUS in asymptomatic patients changes management or patient outcomes. Methods: A retrospective chart review of asymptomatic patients who underwent EGD prior to EUS over the last 4 years was conducted. Patients with symptoms that warranted an EGD were excluded. We estimated a sample size of 150 for 80% power and significance level of 0.05. Chi-Square analysis was used. Results: 1100 charts were reviewed, and 158 patients were included. Mean age was 60.5 years. 63 patients were males. It was noted that 23.4% and 35.4% were using alcohol or tobacco respectively, while 30% were on antiplatelet therapy. Most patients underwent EUS due to a pancreatic indication followed by a biliary indication (figure 1). Among all EGDs, only 33 were completely normal. 125 were associated with benign mucosal findings; 11 cases of Barrett’s esophagus and 4 cases of GI malignancy were detected as well. These findings lead to changes in patient management (figure 2). Overall, 67% of patients had some changes in their managment. There was a statistically significant association between male gender and detection of malignant lesions (P 0.013). Alcohol use was associated with findings on EGD as well as a need for an intervention, as a medication modification (P 0.05), tissue sampling (P 0.034) and schedule a follow procedure (P 0.046) (figure 3). Finally, EGD prior to EUS was safe and not associated with increased complications compared to EUS alone. Conclusion: Our study showed that performing an EGD prior to EUS in the absence of luminal or mucosal symptoms is safe and changed management in 67% of asymptomatic individuals.479_A Figure 1. Pie graph showing the percentages of EUS indications (Pancreatic and biliary indications represent the majority of cases)479_B Figure 2. Different intervention and change in management done as a result of the EGD findings479_C Figure 3. Alcohol’s association with change in management