Upper Endoscopy (EGD)

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What is an upper endoscopy?

Upper endoscopy, also known as esophagogastroduodenoscopy (EGD), is a procedure used to examine the lining of the esophagus (swallowing tube), stomach, and upper part of the small intestine (duodenum). The doctor may perform this procedure to diagnose and treat when possible certain disorders of the upper GI tract. Often it is used to investigate symptoms of abdominal pain, difficulty swallowing, prolonged nausea & vomiting, heartburn, unexplained weight loss, anemia, or blood in your bowel movements.

There are many other reasons your doctor may want to perform this test and you should ask him/her about their reasons. Upper endoscopy should be performed by doctors who have received special training in this procedure, and are assisted by specially trained nurses and technicians.

Animation of an upper endoscopy.

Preparation

Upon arrival for your test your doctor will again review the procedure and answer any of your questions. You will be asked about any allergies or general health problems that you may have. You will then be asked to sign a consent form indicating your agreement to proceed with the test.

It is obviously important to have an empty stomach for this test so you should not have anything to eat or drink (except small sips of water to take any oral medications with) for at least 6 hours prior to your procedure. Do not take any antacids, aspirin, or ibuprofen (Advil, Motrin, Alleve).

Most of the time EGD is performed under "conscious sedation." You will be given a combination of intravenous medications, which make you very relaxed and sleepy during the procedure. You may not remember anything about the procedure itself. Because of these medications you will not be able to drive yourself and should not sign legal documents until the next day. You will need a friend or relative to drive you home.

Examination

After signing the consent form you will put on a hospital gown and will remove any glasses, contacts, and dentures. An IV needle will be placed into a vein in your arm or hand. Fluids and medications will be administered through this IV. You will be taken into a special room for the procedure and asked to lie on your right side. A local anesthetic (with a bitter taste) will be sprayed into your mouth to make it numb and reduce gagging. Monitoring devices will be placed on your skin to measure blood pressure, heart rate, and blood oxygen during the procedure.

A female physician showing light at tip of endoscope.
An endoscope, which has a light and
small video camera, allows the
physician to see inside the body.

After you are sleepy, the doctor will place the thin flexible tube (endoscope) through the mouthguard. When you swallow he will gently advance the scope down the esophagus. A small video camera on the tip of the scope allows the doctor to see. Special controls allow the doctor to: move the tip of the instrument in certain directions; blow air into the gut; or, to suck secretions and waste residuals out to clear his view. There is a also small channel in the endoscope to pass special instruments through, which the doctor may need for diagnosis or treatment.

Although initially you may feel like gagging this will quickly pass and you will not feel any of the diagnostic maneuvers or treatments which may need to be performed. The endoscope will not interfere with your breathing in any way.

After carefully examining your esophagus, the endoscope will be advanced into your stomach. A small amount of air will be added to distend your stomach to gain a better view. All areas in your stomach will be examined.

Next, the endoscope is advanced through the pylorus (the opening between the stomach and duodenum). You may feel some slight pressure here but should not experience any pain. The first portion of your small intestine (duodenum) is then carefully examined for any abnormalities. After this, any diagnostic or therapeutic maneuvers will be performed and the scope will be gently withdrawn from your mouth. The entire procedure usually takes between 10–30 minutes.

After the Procedure

Over the years, advances have made possible the endoscopic treatment of diseases, which in the past have required surgery. There are many useful treatments, which may be employed during EGD. Certain disorders of the gut can result in serious bleeding.

Varices are large "varicose veins" found in the stomach and esophagus especially in patients with liver disease. They can rupture and cause severe bleeding. They can be treated at the time of endoscopy by injecting them with medicine (sclerotherapy) or by placing rubber bands on them. Similarly, ulcers in the stomach and duodenum and abnormal blood vessels (AVM's) can cause bleeding. These can be treated by injecting medicine in them or by applying electricity & heat to them through a special catheter (plastic tube) at the end of the endoscope to cauterize them. Once again you cannot feel any of these treatments.

A view through an endoscope of a healthy, normal esophagus.
A view through an endoscope of a healthy, normal esophagus.

Foreign bodies (batteries, coins, chicken or fish bones, etc.) that have been intentionally or accidentally swallowed may also be removed from the upper GI tract during upper endoscopy without the need for surgery. If any narrowing or strictures are found in the esophagus, stomach, or duodenum these can usually be dilated (stretched) using balloons or other dilating devices. In some extreme cases, usually involving inoperable tumors, splinting devices called "stents" can be left behind. Stents are plastic & metal mesh tubes, which expand once they have been placed to keep blockages in the gut open.

Finally, in some patients who can no longer eat in a conventional way, a percutaneous endoscopic gastrostomy (PEG) tube can be placed at the time of EGD. This small feeding tube is placed through the skin and into the stomach under endoscopic control. There are other therapies, which may be performed at the time of EGD, and you should discuss these with your doctor prior to your procedure.

Diagnosis at EGD

Many times a diagnosis can be made when abnormalities are found while viewing the upper GI tract. However, it is often necessary to take a small biopsy (sample of tissue) to aid in or confirm the diagnosis. These specimens are obtained with special biopsy forceps and you cannot feel them when they are taken. Special brushes can obtain other cell samples from the lining of the upper GI tract for cytology examination. If inflammation or erosion of the esophagus (esophagitis), stomach (gastritis), or duodenum (duodenitis) is noted, biopsies can be helpful in determining the cause. If inflammation or ulcers are present in the stomach or duodenum, a biopsy can be taken to look for the presence of a bacteria (Helicobacter pylori) which has been proven to cause some ulcers and can be treated with antibiotics if found. Similarly, if any nodules (bumps), masses, or tumors are found, biopsies can help determine if they are benign (non-cancerous) or malignant (cancerous). Sometimes other biopsies are taken even if the lining of the upper GI tract appears normal to look for microscopic evidence of diseases of the gut which might be causing certain symptoms, or to screen for certain diseases.

Endoscopy Treatments

Over the years, advances have made possible the endoscopic treatment of diseases, which in the past have required surgery. There are many useful treatments, which may be employed during EGD. Certain disorders of the gut can result in serious bleeding. Varices are large "varicose veins" found in the stomach and esophagus especially in patients with liver disease. They can rupture and cause severe bleeding. They can be treated at the time of endoscopy by injecting them with medicine (sclerotherapy) or by placing rubber bands on them. Similarly, ulcers in the stomach and duodenum and abnormal blood vessels (AVM's) can cause bleeding. These can be treated by injecting medicine in them or by applying electricity & heat to them through a special catheter (plastic tube) at the end of the endoscope to cauterize them. Once again you cannot feel any of these treatments. Foreign bodies (batteries, coins, chicken or fish bones, etc.) that have been intentionally or accidentally swallowed may also be removed from the upper GI tract during upper endoscopy without the need for surgery. If any narrowing or strictures are found in the esophagus, stomach, or duodenum these can usually be dilated (stretched) using balloons or other dilating devices. In some extreme cases, usually involving inoperable tumors, splinting devices called "stents" can be left behind. Stents are plastic & metal mesh tubes, which expand once they have been placed to keep blockages in the gut open. Finally, in some patients who can no longer eat in a conventional way, a percutaneous endoscopic gastrostomy (PEG) tube can be placed at the time of EGD. This small feeding tube is placed through the skin and into the stomach under endoscopic control. There are other therapies, which may be performed at the time of EGD, and you should discuss these with your doctor prior to your procedure.

Risks

Although upper endoscopy is a frequently used modality for diagnosing and treating a number of GI disorders, no medical technique is completely safe and there are potential complications with upper endoscopy. There is a small risk of having a reaction to the medications used for sedation or to any antibiotics that may be given prior to the procedure. You will be monitored closely during the procedure and there are medications that will reverse some of the adverse effects of those medications used during the procedure if necessary. There is a small risk of infection. This risk is so small that antibiotics are not routinely given prior to the procedure. In certain circumstances such as heart valve problems, prior heart infections (endocarditis), previously placed artificial joints, or certain liver problems your doctor may want to give you antibiotics before the procedure to reduce the risk of infection. There is a small risk of bleeding from the procedure. Rarely is it necessary to give a blood transfusion or other treatments such as surgery. Bleeding is usually controlled through the endoscope. Another rare complication from EGD is perforation. This occurs when the tip of the endoscope goes through a weakened part of the gut wall resulting in a hole. This almost always requires surgery to correct but is a very uncommon complication of EGD. When placing a percutaneous endoscopic gastrostomy (PEG) tube the risk of bleeding and infection are slightly higher and antibiotics are usually given prior to this procedure.

Since there are a number of variables involved, it is difficult to generalize about the exact risks of EGD in various settings, so it is very important to talk to your doctor about your specific risks before you have any procedure. If after an EGD you experience any severe abdominal pain, fever, increased blood in your stools or vomit, extreme dizziness/ lightheadedness you should not hesitate to call your doctor since early recognition of post procedure complications greatly improves your outcome.