EGD - esophagogastroduodenoscopy

Answer 1

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.

Alternative Names

Esophagogastroduodenoscopy; Upper endoscopy; Gastroscopy

How the test is performed

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.

How to prepare for the test

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.

How the test will feel

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.

Why the test is performed

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.

Normal Values

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

What abnormal results mean

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)

What the risks are

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.

Special considerations

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

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

References

Grainek IM, Barkun AN, Bardou M. Management of acute bleeding from a peptic ulcer. N Engl J Med. 2008;359(9):928-937.

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.

Answer 2

Definition

Esophagogastroduodenoscopy (EGD) is a test to examine the lining of the esophagus (the tube that connects your throat to your stomach), stomach, and first part of the small intestine. It is done with a small camera (flexible endoscope) which is inserted down the throat.

Alternative Names

Esophagogastroduodenoscopy; Upper endoscopy; Gastroscopy

How the test is performed

You will be given a sedative and a painkiller (analgesic). You should feel no pain and not remember the procedure. A local anesthetic may be sprayed into your mouth to prevent you from coughing or gagging 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, a needle (IV) will be inserted into a vein in your arm to give you medications during the procedure.

You will be instructed to lie on your left side.

After the sedatives have taken effect:

• The endoscope is inserted through the esophagus (food pipe) to the stomach and duodenum. Air is put into the endoscope to make it easier for the doctor to see.
• The lining of the esophagus, stomach, and upper duodenum is examined. Biopsiescan be taken through the endoscope. Biopsies are tissue samples that are looked at under the microscope.
• Different treatments may be done, such as stretching or widening a narrowed area of the esophagus.

After the test is finished, you will not be able to have foods and liquids until your gag reflex returns (so you don't choke).

The test lasts about 5 to 20 minutes.

How to prepare for the test

You will not be able to eat anything for 6 to 12 hours before the test. You must sign an informed consent form. You may be told to stop taking aspirin and other blood-thinning medicines for several days before the test.

How the test will feel

The local anesthetic makes swallowing difficult. This wears off shortly after the procedure. The endoscope may make you gag.

You may feel gas, and the movement of the scope in your abdomen. You will not be able to feel the biopsy. Because of the sedation, you may not feel any discomfort and have no memory of the test.

When you wake up, you may feel a little bloated from the air that was put into your body through the endoscope. This feeling will wear off in a short period of time.

Why the test is performed

EGD may be done if you have symptoms that are new, cannot be explained, or are not responding to treatment, such as:

• Black or tarry stools or vomiting blood
• Bringing food back up (regurgitation)
• Feeling full sooner than normal or after eating less than usual
• Feeling that food is stuck behind the breastbone
• Heartburn
• Low blood count (anemia) that cannot be explained
• Pain or discomfort in the upper abdomen
• Swallowing problems or pain with swallowing
• Weight loss that cannot be explained
• Nausea or vomiting that does not go away

Your doctor may also order this test if you:

• Have cirrhosis of the liver, to look for swollen veins (called varices) in the walls of the lower part of the esophagus, which may begin to bleed
• Have Crohn's disease
• Need more follow-up or treatment for a condition that has been diagnosed

The test may also be used to take a piece of tissue for biopsy.

Normal Values

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

What abnormal results mean

An abnormal EGD may be the result of:

• Celiac disease
• Esophageal rings
• Esophageal varices (swollen veins in the lining of the esophagus caused by liver cirrhosis)
• Esophagitis(when the lining of the esophagus becomes inflamed or swollen)
• Gastritis (when the lining of the stomach and duodenum becomes inflamed or swollen)
• Gastroesophageal reflux disease (a condition in which food or liquid from the stomach leaks backwards into the esophagus)
• Hiatal hernia(a condition in which part of the stomach sticks up into the chest through an opening in the diaphragm)
• Lower esophageal ring
• Mallory-Weiss syndrome (tear in the esophagus)
• Narrowing of the esophagus
• Tumors or cancer in the esophagus, stomach, or duodenum (first part of small intestine)
• Ulcers - gastric (stomach) or duodenal (small intestine)

What the risks are

There is a small chance of a hole (perforation) in the stomach, duodenum, or esophagus. There is also a small risk of bleeding at the biopsy site.

You could have a reaction to the medicine used during the procedure, which could cause:

• Apnea (not breathing)
• Difficulty breathing (respiratory depression)
• Excessive sweating
• Low blood pressure (hypotension)
• Slow heartbeat (bradycardia)
• Spasm of the larynx (laryngospasm)

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

References

Grainek IM, Barkun AN, Bardou M. Management of acute bleeding from a peptic ulcer. N Engl J Med. 2008;359(9):928-937.

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.

Reviewed By

Review Date: 11/22/2011

Todd Eisner, MD, Private practice specializing in Gastroenterology, Boca Raton, FL, Clinical Instructor, Florida Atlantic University School of Medicine. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.