Esophagogastroduodenoscopy

In esophagogastroduodenoscopy, a flexible, lighted viewing tube (endoscope) is passed into the throat and through the upper digestive tract (esophagus, the stomach, and the uppermost portion of the small intestine, or duodenum). Fiberoptic cables permit a physician to visually inspect the lining of these digestive organs for any signs of disease or abnormality; in some cases, instruments are passed through the scope to obtain tissue biopsies for microscopic examination. EGD may also be done therapeutically, for example, to remove polyps, control bleeding, or remove a swallowed object.

Purpose of the Esophagogastroduodenoscopy

  • To detect abnormalities of the esophagus, stomach, and duodenum, particularly in people with gastrointestinal (GI) symptoms—such as heartburn, difficulty swallowing, weight loss, abdominal pain, and diarrhea—that have not been explained by contrast x-rays such as a barium swallow or upper GI series
  • To confirm a diagnosis of esophageal or stomach cancer or some other abnormality found on a contrast x-ray
  • To help diagnose symptoms and conditions such as abdominal pain, black or tarry stools, chronic liver disease or cirrhosis, Crohn's disease, feeling abnormally full after eating less than usual, gastroparesis, heartburn, narrowing of the esophagus or esophageal tumors, swallowing difficulties or painful swallowing, unexplained anemia (low red blood cell count), unexplained weight loss, vomiting blood, and vomiting that does not resolve
  • To evaluate the stomach or duodenum after surgery
  • Used therapeutically to remove polyps, widen narrowed passages, stop active bleeding, or remove obstructions.

Who Performs Esophagogastroduodenoscopy

  • A physician who is trained in endoscopic procedures

Special Concerns about Esophagogastroduodenoscopy

  • EGD should not be done in people with uncontrolled bleeding in the GI tract (until they are stable); those with esophageal diverticula (abnormal outpouchings); if there is a suspected perforation of the GI tract; or in people who have had recent upper GI surgery.
  • The procedure may not be possible if food or blood is present in the stomach.
  • You must wait at least 2 days after having a barium test before undergoing this procedure; the presence of barium interferes with visual inspection.
  • This test may provoke some anxiety, but it is not painful. You will not be able to speak when the scope is in your throat, but your breathing will not be affected.
  • In some cases, an extra long endoscope may be used to visualize or perform biopsies of the small intestine beyond the duodenum; this procedure is known as enteroscopy.

Before the Esophagogastroduodenoscopy

  • Tell your doctor or nurse about any known allergies or sensitivities, including to medications and foods.
  • You will be instructed to fast for 6 to 12 hours before the test.
  • Inform your doctor if you regularly take nonsteroidal anti-inflammatory drugs (such as aspirin, ibuprofen, or naproxen). These medications must be discontinued for 7 days before the test to reduce the risk of bleeding.
  • Tell your doctor or nurse ff you must take an antibiotic prior to dental work – you may need antibiotics before this test.
  • Empty your bladder before this test.
  • If you wear dentures, contacts, or glasses, remove them prior to the test.
  • A sedative medication will likely be administered through an intravenous (IV) catheter inserted in a vein in your arm. You may drift into a light sleep during the procedure.

What You Experience during Esophagogastroduodenoscopy

  • You lie on your left side on a table.
  • A local anesthetic (such as lidocaine) is sprayed into your mouth and throat to suppress the gag reflex when the scope is inserted. A plastic mouthpiece may be inserted to hold your mouth open and prevent you from biting down on the scope.
  • Next, you will bend your head forward and open your mouth. The doctor will guide the scope into your throat with his finger. When the scope reaches a certain point, the doctor will straighten your head to aid the advancement of the scope down through your esophagus.
  • If needed, the doctor may instill a small amount of air through the scope to dilate the esophagus and stomach for better viewing. This may cause you to belch or pass gas.
  • The doctor carefully inspects the lining of your esophagus, stomach, and duodenum, looking for any abnormalities.
  • If appropriate, a biopsy forceps or other instruments may be inserted through the scope to obtain tissue samples or cells for laboratory analysis. If necessary, surgical treatments may be performed through the scope, such as obliteration of polyps with heat.
  • Upon completion of the visual inspection, excess air and gastric secretions are removed through the scope, and the scope is withdrawn.
  • The test lasts about 5 to 20 minutes.

Risks and Complications of Esophagogastroduodenoscopy

  • Possible complications include bleeding from a biopsy site; aspiration of stomach contents into the lungs; low blood pressure or breathing difficulties due to oversedation; and inadvertent perforation of the esophagus, stomach, or duodenum.
  • In fewer than 1 out of 1,000 patients, an adverse reaction to the anesthesia, medication or tranquilizer used causes apnea (not breathing), bradycardia, excessive sweating orlaryngospasm (spasm of the larynx).

After the Esophagogastroduodenoscopy

  • You will rest in a recovery room until the sedative medication wears off. Your vital signs will be checked periodically, and you will be observed for signs of complications. Arrange for someone to drive you home.
  • Do not eat or drink until your gag reflex returns, usually in a few hours. (Touching the back of the throat with a tongue depressor tests for this reflex.)
  • You may experience belching, flatulence, or gas pains after the procedure.
  • You may feel hoarse or have a sore throat for several days. Lozenges or a warm saline gargle may provide some relief.
  • If a biopsy was performed, you may have black, tarry stools due to bleeding for a short period of time.
  • Contact your doctor immediately if you develop a fever, or if you experience persistent difficulty swallowing; black, tarry stools; or bloody vomit.

Results of Esophagogastroduodenoscopy

  • The doctor will note any abnormalities such as bleeding, inflammation, abnormal growths, or ulcers that were discovered during the visual inspection.
  • Various laboratory tests may be necessary to pinpoint a diagnosis. For example, tissue samples may be cultured to identify the presence of infectious organisms, such as Helicobacter pylori (a bacterium believed to be responsible for some stomach ulcers). Biopsied tumors and excised polyps are examined under a microscope for signs of cancer or another abnormality.

Source:

The Johns Hopkins Consumer Guide to Medical Tests

Simeon Margolis, M.D., Ph.D., Medical Editor

Updated by Remedy Health Media

Publication Review By: the Editorial Staff at Healthcommunities.com

Published: 12 Jan 2012

Last Modified: 12 Jan 2012