Esophagogastroduodenoscopy (EGD)

What is Esophagogastroduodenoscopy (EGD)

Esophagogastroduodenoscopy is a procedure to examine the lining of the esophagus, stomach, and first part of the small intestine (duodenum). This procedure is done to check for problems such as inflammation, bleeding, ulcers, or growths.

During this procedure, a long, flexible, lighted tube with a camera attached (endoscope) is inserted down the throat.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding.
• A tear (perforation) in the esophagus, stomach, or duodenum.
• Trouble breathing.
• Excessive sweating.
• Spasms of the larynx.
• A slowed heartbeat.
• Low blood pressure.

How should patients be prepared for an esophagogastroduodenoscopy (EGD)? 

After initial stabilization and resuscitation is performed (see [CR] and [CR] ), intubation and deep sedation should be considered in patients with altered mental status, copious hematemesis, suspicion for variceal bleeding, or alcohol dependence. The patient should take nothing by mouth. Informed consent is obtained by the endoscopist prior to the procedure. In the setting of substantial bleeding, erythromycin can be infused 30 minutes prior to the EGD to improve visualization.

What happens before the procedure?

• Follow instructions from your health care provider about eating or drinking restrictions.
• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood.Do nottake these medicines before your procedure if your health care provider instructs you not to.
• Plan to have someone take you home after the procedure.
• If you wear dentures, be ready to remove them before the procedure.

What happens during the procedure?

• To reduce your risk of infection, your health care team will wash or sanitize their hands.
• An IV tube will be put in a vein in your hand or arm. You will get medicines and fluids through this tube.
• You will be given one or more of the following:
  • A medicine to help you relax (sedative).
  • A medicine to numb the area (local anesthetic). This medicine may be sprayed into your throat. It will make you feel more comfortable and keep you from gagging or coughing during the procedure.
  • A medicine for pain.
• A mouth guard may be placed in your mouth to protect your teeth and to keep you from biting on the endoscope.
• You will be asked to lie on your left side.
• The endoscope will be lowered down your throat into your esophagus, stomach, and duodenum.
• Air will be put into the endoscope. This will help your health care provider see better.
• The lining of your esophagus, stomach, and duodenum will be examined.
• Your health care provider may:
  • Take a tissue sample so it can be looked at in a lab (biopsy).
  • Remove growths.
  • Remove objects (foreign bodies) that are stuck.
  • Treat any bleeding with medicines or other devices that stop tissue from bleeding.
  • Widen (dilate) or stretch narrowed areas of your esophagus and stomach.
• The endoscope will be taken out.

The procedure may vary among health care providers and hospitals.

How quickly should Esophagogastroduodenoscopy be performed? 

Endoscopy should be performed within 24 hours of admission, after hemodynamic stabilization and resuscitation. More urgent endoscopy (within 12 hours) may be needed in patients with significant ongoing blood loss such as those with a bloody NG aspirate, systolic blood pressure (SBP) lower than 100 mm Hg, pulse faster than 100 bpm, or a Blatchford score greater than or equal to 12.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored often until the medicines you were given have worn off.
• Do noteat or drink anything until the numbing medicine has worn off and your gag reflex has returned.

Esophagogastroduodenoscopy, Care After

Refer to this sheet in the next few weeks. These instructions provide you with information about caring for yourself after your procedure. Your health care provider may also give you more specific instructions. Your treatment has been planned according to current medical practices, but problems sometimes occur. Call your health care provider if you have any problems or questions after your procedure.

How do findings at endoscopy guide risk stratification and treatment? 

Endoscopic findings play an important role in patient assessment and management. Stigmata of recent hemorrhage describe the appearance of an ulcer at the time of endoscopy. The most commonly used classification system for peptic ulcers is the Forrest classification, which classifies endoscopic stigmata according to the risk of rebleeding and mortality.

Forrest Classification of Peptic UlcersAdapted from Laine L, et al. Management of patients with ulcer bleeding. Am J Gastroenterol 2012;107(3):345–360.

Forrest Classification	Description of Endoscopic Stigmata	Treatment	Rebleeding Rate without Endoscopic Therapy	Mortality without Endoscopic Therapy
1A	Spurting blood	IV PPI bolus + infusion, endoscopic treatment	70%	11%
1B	Oozing blood	IV PPI bolus + infusion, endoscopic treatment	30%
IIA	Nonbleeding visible vessel	IV PPI bolus + infusion, endoscopic treatment	43%	11%
IIB	Adherent clot	IV PPI bolus + infusion, consider endoscopic treatment	22%	7%
IIC	Pigmented flat spot	Oral PPI	10%	3%
III	Clean based ulcer		5%	2%

IV, Intravenous; PPI, proton pump inhibitor.

What can I expect after the procedure?

After the procedure, it is common to have:

• A sore throat.
• Nausea.
• Bloating.
• Dizziness.
• Fatigue.

Follow these instructions at home:

• Do noteat or drink anything until the numbing medicine (local anesthetic) has worn off and your gag reflex has returned. You will know that the local anesthetic has worn off when you can swallow comfortably.
• Do notdrive for 24 hours if you received a medicine to help you relax (sedative).
• If your health care provider took a tissue sample for testing during the procedure, make sure to get your test results. This is your responsibility. Ask your health care provider or the department performing the test when your results will be ready.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You cannot stop coughing.
• You are not urinating.
• You are urinating less than usual.

Get help right away if:

• You have trouble swallowing.
• You cannot eat or drink.
• You have throat or chest pain that gets worse.
• You are dizzy or light-headed.
• You faint.
• You have nausea or vomiting.
• You have chills.
• You have a fever.
• You have severe abdominal pain.
• You have black, tarry, or bloody stools.