EGD - esophagogastroduodenoscopy

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) that is inserted down the throat.

Alternative Names

Esophagogastroduodenoscopy; Upper endoscopy; Gastroscopy

How the test is performed

You will receive 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. Biopsies can 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 - 20 minutes.

How to prepare for the test

You will not be able to eat anything for 6 - 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.

Special considerations

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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.