EGD - esophagogastroduodenoscopy

Definition

Esophagogastroduodenoscopy (EGD) is an examination of the lining of the esophagus, stomach, and upper duodenum with a small camera (flexible endoscope) which is inserted down the throat.

Esophagogastroduodenoscopy; Upper endoscopy; Gastroscopy

You will be given a sedative and an analgesic (painkiller). You should feel no pain and not remember the procedure. A local anesthetic may be sprayed into your mouth to suppress the need to cough or gag when the endoscope is inserted. A mouth guard will be inserted to protect your teeth and the endoscope. Dentures must be removed.

In most cases, an intravenous line will be inserted into your arm to administer medications during the procedure.

You will be instructed to lie on your left side.

After the sedatives have taken effect:

• The endoscope is advanced through the esophagus (food pipe) to the stomach and duodenum. Air is introduced through the endoscope to enhance viewing.
• The lining of the esophagus, stomach, and upper duodenum is examined, and biopsies can be taken through the endoscope. Biopsies are tissue samples that are reviewed under the microscope.
• Different treatments may be performed, such as stretching or widening a narrowed area of the esophagus.

After the test is completed, food and liquids will be restricted until your gag reflex returns (so you don't choke).

The test lasts about 5 to 20 minutes.

Fasting is required overnight (6 to 12 hours before the test). An informed consent form must be signed. You may be told to stop aspirin and other blood-thinning medications for several days before the test.

The local anesthetic makes swallowing difficult. This wears off shortly after the procedure. The endoscope may stimulate some gagging in the back of the throat. There may be a sensation of gas, and the movement of the scope may be felt in the abdomen. Biopsies cannot be felt. Because of the intravenous sedation, you may not feel any discomfort and may have no memory of the test.

When you wake up, you may feel a little bloated from the air that is introduced through the endoscope, but this will wear off in a short period of time.

Your doctor may order this test if you have any of the following conditions or symptoms:

• Abdominal pain
• Black or tarry stools
• Chronic liver disease or cirrhosis
• Crohn's disease
• Feeling full sooner than normal or after eating less than usual
• Gastroparesis
• Heartburn
• Narrowing or tumors of the esophagus
• Swallowing difficulties or pain with swallowing
• Unexplained anemia
• Unexplained weight loss
• Vomiting blood
• Vomiting that does not go away

The test may also be used to obtain a tissue specimen for biopsy.

The esophagus, stomach, and duodenum should be smooth and of normal color. There should be no bleeding, growths, ulcers, or inflammation.

An abnormal EGD may be the result of:

• Celiac disease
• Esophageal rings
• Esophageal varices (a sign of end-stage liver disease)
• Esophagitis
• Gastroesophageal reflux disease
• Lower esophageal ring
• Inflammation of the stomach and duodenum
• Mallory-Weiss syndrome (tear in the esophagus)
• Strictures or narrowing of the esophagus
• Tumors or cancer in the esophagus, stomach, duodenum (first part of small intestine)
• Ulcers - gastric (stomach) or duodenal (small intestine)
• Zenker diverticula (abnormal pouches in the lining of the intestines)

There is a small chance of perforation (hole) of the stomach, duodenum, or esophagus. There is also a small risk of bleeding at the biopsy site. A patient could have an adverse reaction to the anesthetic, medication, or tranquilizer. This reaction could cause:

• Apnea (not breathing)
• Bradycardia
• Excessive sweating
• Hypotension (low blood pressure)
• Laryngospasm (spasm of the larynx)
• Respiratory depression (difficulty breathing)

The overall risk is less than 1 out of 1,000 people.

If you develop any of the following after the test, contact the health care provider:

• Black stools
• Blood in vomit
• Difficulty swallowing
• Fever
• Pain

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Maish M. Esophagus. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008: chap 41.

Mercer DW, Robinson EK. Stomach. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008: chap 47.

Pasricha PJ. Gastrointestinal endoscopy. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 136.