EGD, also known as upper gastrointestinal (GI) endoscopy, is a visual examination of the upper digestive tract. It begins with examination of the esophagus or swallowing tube. Next is the stomach, a pouch that makes acid and breaks the food into smaller particles. Finally the first part of the small intestine or duodenum is visualized. The duodenum is where food meets bile from the liver and digestive juices from the pancreas.
- 01. Reasons for the Exam
- 02. Abnormalities which May be Detected
- 03. Equipment
- 04. Benefits
- 05. Side Effects and Risks
- 06. Preparation
- 07. Alternative Testing
- 08. Additional Instructions
- 09. Before the Procedure
- 10. The Procedure
- 11. After the Procedure
- 12. Results
- 13. Answers to Common Questions
01. Reasons for the Exam
There are many disorders which can involve the upper GI tract and which can be diagnosed or followed using endoscopy. Common symptoms which may lead to endoscopy are heartburn, pains in the stomach or chest, gastrointestinal bleeding, difficulty in swallowing, nausea and vomiting.
02. Abnormalities which may be detected by EGD include
- Ulcers – breakdowns in the lining of the organs
- Esophagitis – inflammation of the esophagus
- Gastritis – inflammation of the stomach
- Tumors or Cancer
- Obstructions – blockages or narrowings
The endoscope is a thin flexible lighted tube which is passed through the mouth and is capable of seeing the upper GI tract. It contains a minute optically sensitive computer chip in the tip which transmits the signal onto a video screen. Dials permit the physician to steer the instrument in every direction. A channel through the instrument permits suctioning or the collection of samples. Other instruments can be passed through this channel to take biopsies, remove polyps, or stop bleeding.
EGD is the most accurate means of identifying abnormalities in the upper GI tract. It can be performed safely and with minimal discomfort for you. In addition to providing a diagnosis, in many cases it enables the physician to perform specific treatment. Bleeding can be controlled, polyps removed, and obstructions relieved.
05. Risks and Side Effects
No test is 100% accurate and infrequently EGD can miss abnormalities which are present. A mild sore throat occasionally follows the procedure. You may have a feeling of bloating which is also temporary. Complications are very uncommon. Bleeding can occur following a biopsy or removal of a polyp, but it is usually minimal and rarely requires a blood transfusion or surgery. Over sedation occurs infrequently and almost always can be reversed. A localized irritation of the vein can occur at the IV site resulting in a tender lump which may last for several weeks. Application of hot moist towels may relieve the discomfort. Other risks include complications of underlying heart or lung disease and reactions to one of the sedatives. Perforation (a tear in one of the organs) is exceedingly rare and occurs in approximately one in 4,000 cases. Any of these complications could involve hospitalization, emergency surgery, or in an exceptionally rare case death.
For the physician to have a clear view, the stomach must be empty. It is very important that you have nothing to eat or drink after midnight the evening before the procedure. If your procedure is scheduled in the afternoon, you may be instructed to have an early clear liquid breakfast. An exception to this is prescription medication. You can take these on the morning or afternoon of the exam with a few sips of water. It is especially important to take any high blood pressure or heart medication. If you take any of the following medications, notify our office prior to the procedure because they may need to be stopped or the dosage may need to be adjusted.
- Coumadin (Warfarin)
- Insulin or other medication for diabetes
07. Alternative Testing
The primary alternative to an EGD is an upper GI series or barium x-ray. This procedure is less costly, but it is less accurate and it does not permit the application of treatments. Some abnormalities such as gastritis would be completely missed by x-rays. Tissue and fluid samples cannot be collected this way. Other radiographic studies such as an ultrasound or CT scan provide little information about the lining of the digestive tract which is where most of the abnormalities occur.
- If you are on blood thinner medication, such as Coumadin or Warfarin, it is important to let us know well in advance of your appointment. If you are currently taking these medications and have not already given that information to our office, please call immediately. A nurse will contact you about instructions about taking your blood thinner prior to this procedure.
- If you are on the medication Carafate, notify our office prior to the procedure for instructions. The medication will need to be stopped before your procedure.
- YOU MUST HAVE SOMEONE TO DRIVE YOU HOME OR THE DOCTOR WILL NOT DO THE PROCEDURE. If your driver does not plan to stay during your procedure, you will need to provide a phone number where that person can be contacted.
- Using a small amount of water, take your prescription medications as you usually do unless you have been instructed to “hold” the medication prior to the procedure. It is very important that you take your blood pressure or heart medication as usual.
- Bring a list of your current medications and any allergies to medication.
- Bring your insurance cards with you.
- If you are a diabetic, check your blood sugar at home before your procedure.
- If you have an implanted cardiac defibrillator, it is very important that you bring the card identifying the device manufacturer, model and serial number.
- You may wear your glasses, dentures or hearing aids. It is best to leave your jewelry at home.
If you take any of the following medications notify our office prior to the procedure because they may need to be stopped or the dosage may need to be adjusted.
- Coumadin (Warfarin)
- Insulin or other medication for diabetes
09. Before the Procedure
You will be asked to arrive well ahead of the scheduled procedure time. Please bring your insurance cards with you. It is advised that you leave your valuables at home or with whomever accompanies you. YOU MUST HAVE SOMEONE TO DRIVE YOU HOME OR THE PROCEDURE WILL NOT BE PERFORMED.
A brief medical history will be reviewed with you by a nurse. Please bring a list of your current medications and any allergies to medications. You will be asked to remove your clothing and change into a patient gown.
10. The Procedure
An intravenous (IV) catheter will be placed into your arm so that medications can be given for sedation. It is generally not a painful exam, but the sedation helps you to relax. Most of the effects of the sedation persist for 15-60 minutes, and you may not be able to recall the procedure afterwards. Your throat is usually anesthetized with a spray or liquid to minimize the gag reflex. The endoscope is then gently inserted into the upper esophagus and advanced through the upper digestive tract. The endoscope is small compared to the airway and does not interfere with normal breathing. You will be monitored closely throughout the exam. As the exam takes place, any additional necessary procedures are performed. For example, a biopsy can be performed where a small piece of tissue is removed for microscopic analysis. A bleeding vessel can be cauterized (burned) or injected with medication to stop the bleeding. A polyp can be removed with a wire snare and electrocautery.
11. After the Procedure
You will remain in the recovery area for one-half to one hour after the procedure depending on your vital signs and level of consciousness. You may feel bloated from the air used during the exam.
The medication given to you during the examination may affect your reflexes and judgment. Therefore you should not drive a car, operate machinery, or make any legally binding decisions for the remainder of the day.
Following the exam your physician will discuss the results with you and your family. If you want family members to hear the results of your test, they should remain in the waiting area for the duration of your stay.