Esophagogastroduodenoscopy (EGD)

By: Gerby Coronel, M.D.
Edited By: Felix Domingo, Jr. M.D.

• is a diagnostic endoscopic procedure that visualizes the upper part of the gastrointestinal tract up to the duodenum.
• is done using a narrow, flexible, telescopic cam era called a gastroscope.
•  It is considered a minimally invasive procedure since it does not require an incision into one of the major body cavities and does not require any significant recovery after the procedure (unless sedation or anaesthesia has been used).
• may be abbreviated EGD
• It is also called upper GI endoscopy (UGIE), gastroscopy or simply endoscopy
  
  

  

Indications

  Diagnostic

• Unexplained anemia (usually along with a colonoscopy)
• Upper gastrointestinal bleeding as evidenced by hematemesis or melena
• Persistent dyspepsia in patients over the age of 40-45 years
• Heartburn and chronic acid reflux - this can lead to a precancerous lesion called Barrett's esophagus
• Persistent vomiting Dysphagia - difficulty in swallowing
• Odynophagia - painful swallowing

Surveillance

• Surveillance of Barrett's esophagus
• Surveillance of gastric ulcer or duodenal ulcer
• Occasionally after gastric surgery

Confirmation of diagnosis/biopsy

• Abnormal barium swallow or barium meal
• Confirmation of celiac disease (via biopsy)

Therapeutic

• Treatment (banding/sclerotherapy) of esophageal varices
• Injection therapy (e.g. epinephrine in bleeding lesions)
• Cutting off of larger pieces of tissue with a snare device (e.g. polyps, endoscopic mucosal resection)
• Application of cautery to tissues
• Removal of foreign bodies (e.g. food) that have been ingested
• Tamponade of bleeding esophageal varices with a balloon
• Application of photodynamic therapy for treatment of esophageal malignancies
• Tightening the lower esophageal sphincter
• Dilating or stenting of stenosis or achalasia
• Percutaneous endoscopic gastrostomy (feeding tube placement)
• Endoscopic retrograde cholangiopancreatography (ERCP) combines EGD with fluoroscopy
• Endoscopic ultrasound (EUS)

Equipment

Endoscope

• Non-coaxial optic fibre system to carry light to the tip of the endoscope
• A chip camera at the tip of the endoscope
• Control handle - this houses the controls

Procedure

The patient is kept NPO (Nil per os) or NBM (Nothing By Mouth) that is, told not to eat, for at least 4-6 hours
before the procedure.

Most patients tolerate the procedure with only topical anaesthesia of the oropharynx using lidocaine spray. However, some patients may need sedation and the very anxious/agitated patient may even need a general anaesthetic.

Informed consent is obtained before the procedure.
 
The patient lies on his/her left side with the head resting comfortably on a pillow.
A mouth-guard is placed between the teeth to prevent the patient from biting on the endoscope.
The endoscope is then passed over the tongue and into the oropharynx. This is the most uncomfortable stage for the patient.

Quick and gentle manipulation under vision guides the endoscope into the esophagus. The endoscope is gradually advanced down the esophagus and is quickly passed through the stomach and through the pylorus to examine the first and second parts of the duodenum.

Any additional procedures are performed after this stage. Still photographs can be made during the procedure and later shown to the patient to help explain any findings.

In its most basic use, the endoscope is used to inspect the internal anatomy of the digestive tract. Often inspection alone is sufficient, but biopsy is a very valuable adjunct to endoscopy. Small biopsies can be made with a pincer (biopsy forceps) which is passed through the scope and allows sampling of 1 to 3 mm pieces of tissue under direct vision. The intestinal mucosa heals quickly from such biopsies.)

What to expect afterwards

You will need to rest until the effects of the sedative have passed. You will usually be able to go home when you feel ready. You will need to arrange for someone to drive you home.

It may take several hours before the feeling comes back into your throat. You shouldn't drink hot drinks until the local anaesthetic has worn off.

You should try to have a friend or relative stay with you for the first 24 hours.

 Results

If you have a biopsy or polyps removed, your results will be ready several days later and will usually be sent to the doctor who recommended your test. At the hospital, your doctor may discuss other findings from the gastroscopy with you before you leave, or you may be given a date for a follow-up appointment.

What are the risks?

Gastroscopy is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications of this procedure.

Side-effects

These are the unwanted, but mostly mild and temporary effects of a successful procedure.

After having a gastroscopy you may:

• have a numb mouth and tongue for a few hours
• feel bloated, but this usually passes quite quickly
• feel sleepy as a result of the sedative
• have a sore throat for a few hours

Complications

• The complication rate is about 1 in 1000. They include:
• aspiration, causing aspiration pneumonia
• have a reaction to the sedative, such as a skin rash or difficulty in breathing
• bleeding
• perforation
• cardiopulmonary problems

Recovering from a gastroscopy

Sedation temporarily affects your coordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards. If you're in any doubt about driving, always follow your doctor's advice and please contact your motor insurer so that you're aware of their recommendations.

Most people have no problems after a gastroscopy, but you should contact your doctor if you:

• cough up or vomit blood
• have abdominal pain which gradually gets worse, or is more severe than any pain that you had before the test
• develop a high temperature