Esophagogastroduodenoscopy

(EGD, Upper Gastrointestinal Endoscopy, Upper GI Endoscopy, Gastroscopy, Esophagoscopy)

Procedure Overview

What is an esophagogastroduodenoscopy?

Esophagogastroduodenoscopy (EGD) is a diagnostic procedure that allows the physician to diagnose and treat problems in the upper gastrointestinal (UGI) tract. The physician uses a long, flexible, lighted tube called an endoscope. The endoscope is guided through the patient's mouth and throat, then through the esophagus, stomach, and duodenum (first part of the small intestine). The physician can examine the inside of these organs and detect abnormalities.

In addition to performing visual examination of the UGI tract with the endoscope, the physician can insert instruments through the endoscope to obtain tissue samples for a biopsy, remove foreign objects, instill air or fluid, stop bleeding, or perform therapeutic procedures, such as endoscopic surgery, laser therapy, or dilatation (opening up). A video camera in the endoscope provides images onto a TV-like monitor.

Other related procedures that may be used to diagnose upper gastrointestinal problems are barium swallow and upper gastrointestinal series. Please see these procedures for additional information.

About the upper GI tract:

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Digestion is the process by which food and liquid are broken down into smaller parts so that the body can use them to build and nourish cells, and to provide energy. Digestion begins in the mouth, where food and liquids are taken in, and is completed in the small intestine.

Digestion involves the mixing of food, the movement of food through the digestive tract, and the chemical breakdown of large molecules of food into smaller molecules.

In a wave-like movement, called peristalsis, muscles propel food and liquid along the digestive tract. The involvement of the upper GI tract includes the following:

• The first major muscle movement is swallowing food or liquid. The start of swallowing is voluntary, but once it begins, the process becomes involuntary and continues under the control of the nerves.
• The esophagus, which connects the throat above with the stomach below, is the first organ into which the swallowed food goes.
• Where the esophagus and stomach join, there is a ring-like valve that closes the passage between the two organs. As food nears the valve, the surrounding muscles relax and allow food to pass into the stomach. The valve then closes.
• The food then enters the stomach, which completes three mechanical tasks of storing and mixing the food, then emptying it into the small intestine.
• The food is digested in the small intestine and dissolved by the juices from the pancreas, liver, and intestine and the contents of the intestine are mixed and pushed forward to allow further digestion.

Reasons for the Procedure

An EGD may be performed to diagnose structural or functional abnormalities of the esophagus, stomach, and/or duodenum. These abnormalities may include, but are not limited to, the following:

• dysphagia (difficulty swallowing)
• weight loss or anorexia (loss of appetite)
• upper abdominal pain or chest pain of a noncardiac origin
• gastroesophageal reflux disease (GERD)
• intractable vomiting (continuous vomiting from an unknown cause)
• strictures (narrowing) or obstructions
• gastrointestinal bleeding and esophageal varices (enlarged veins in the esophagus)
• inflammation and ulcers
• tumors (benign or malignant)
• hiatal hernia - upward movement of the stomach, either into or alongside the esophagus
• damage caused by ingestion of caustic substances (chemicals such as lye, household detergents)

An EGD may be performed therapeutically to control bleeding, remove tumors or polyps (growths), dilate narrowed areas in the upper GI tract (e.g., esophagus), remove foreign objects, perform laser therapy, and place a percutaneous gastrostomy tube (a tube used for tube feeding into the stomach).

Tissue or gastrointestinal fluid samples may be obtained via an endoscope. In addition, an EGD may be used to evaluate the stomach and duodenum after a surgery.

There may be other reasons for your physician to recommend an esophagogastroduodenoscopy.

Risks of the Procedure

As with any invasive procedure, complications can occur. Some possible complications may include, but are not limited to, the following:

• infection
• bleeding
• perforation of the duodenum, esophagus, or stomach

Patients who are allergic to or sensitive to medications, contrast dyes, iodine, shellfish, or latex should notify their physician.

If you are pregnant or suspect that you are pregnant, you should notify your physician.

EGD is contraindicated in patients who have a large aortic aneurysm, Zenker's diverticulum (a herniated pouch in the esophagus), a recent perforated ulcer, or a perforation elsewhere in the GI tract.

There may be other risks depending upon your specific medical condition. Be sure to discuss any concerns with your physician prior to the procedure.

Barium within the intestines from a recent barium procedure may interfere with an EGD.

Before the Procedure

• Your physician will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.
• You will be asked to sign a consent form that gives your permission to do the test. Read the form carefully and ask questions if something is not clear.
• Notify your physician if you are sensitive to or are allergic to any medications, latex, tape, and anesthetic agents (local and general).
• You will be asked to fast for eight hours before the procedure, generally after midnight. You may be given additional instructions about a special diet for one to two days prior to the procedure.
• If you are pregnant or suspect that you are pregnant, you should notify your physician.
• Notify your physician of all medications (prescribed and over-the-counter) and herbal supplements that you are taking.
• Notify your physician if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure.
• Your physician will instruct you about specific ways to prepare your bowel for the test. You may be asked to take a laxative, undergo an enema, use a rectal laxative suppository, and/or drink a special fluid that helps prepare your bowel.
• Patients with diseases of the heart valves may be given antibiotics before the procedure.
• You will be awake during the procedure, but a sedative will be given before the procedure. You will need someone to drive you home afterwards.
• Based upon your medical condition, your physician may request other specific preparation.

During the Procedure

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An EGD may be performed on an outpatient basis or as part of your stay in a hospital. Procedures may vary, depending on your condition and your physician’s practices.

Generally, an EGD follows this process:

1. You will be asked to remove any clothing, jewelry, or other objects that may interfere with the procedure. If you wear dentures, you will be asked to remove them until the procedure has been completed.
2. If you are asked to remove clothing, you will be given a gown to wear.
3. An intravenous (IV) line will be inserted in the arm or hand. A sedative will be injected into the IV.
4. Your heart rate, blood pressure, respiratory rate, and oxygen level will be monitored during the procedure.
5. You will lie on your left side on the x-ray table with your head bent forward.
6. Numbing medication will be sprayed into the back of your throat to prevent gagging as the endoscope is passed down your throat into your stomach. The spray may have a bitter taste to it. Holding your breath while the physician sprays your throat may decrease the taste.
7. You will not be able to swallow the saliva that may collect your mouth during the procedure due to the endoscope in your throat. The saliva will be suctioned from your mouth from time to time.
8. A mouth guard will be placed in your mouth to keep you from biting down on the endoscope and to protect your teeth.
9. Once your throat is numbed and you are sufficiently relaxed from the sedative, the physician will ask you to swallow the endoscope. By using the endoscope’s camera system, the physician will guide the endoscope down the esophagus, through the stomach, and into the duodenum.
10. You may experience a sensation of pressure or bloating as the endoscope is being advanced.
11. If needed for your specific situation, samples of fluid and/or tissue may be taken at any time during the procedure. Other procedures, such as the removal of an obstruction, may be performed while the endoscope is in place.
12. After the examination and procedures have been completed, the endoscope will be withdrawn.

After the Procedure

After the procedure, you will be taken to the recovery room for observation. Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room or discharged to your home. If this procedure was performed as an outpatient, you should plan to have another person drive you home.

You will not be allowed to eat or drink anything until your gag reflex has returned. You may notice some soreness of your throat and pain with swallowing for a few days. This soreness is normal.

You may resume your usual diet and activities after the procedure, unless your physician decides otherwise.

Notify your physician to report any of the following:

• fever and/or chills
• redness, swelling, or bleeding or other drainage from the IV site
• abdominal pain, nausea, and/or vomiting
• black, tarry, or bloody stools

Your physician may give you additional or alternate instructions after the procedure, depending on your particular situation.