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Esophagogastroduodenoscopy (EGD) at Our Los Angeles Center

An upper gastrointestinal endoscopy is a procedure that allows your doctor to look at the interior lining of your esophagus, your stomach and the first part of your small intestine (duodenum) through a thin, flexible viewing instrument called an endoscope. The tip of the endoscope is inserted through your mouth and then gently moved down your throat into the esophagus, stomach and duodenum.

Since the entire upper gastrointestinal (GI) tract can be examined during this test, the procedure is sometimes called esophagogastroduodenoscopy (EGD).

Using the endoscope, your doctor can look for ulcers, inflammation, tumors, infection or bleeding. Tissue samples can be collected (biopsy), polyps can be removed and bleeding can be treated through the endoscope. Endoscopy can reveal problems that do not show up on x-ray tests and it can sometimes eliminate the need for exploratory surgery.

Who Is a Candidate for EGD?

An upper gastrointestinal endoscopy may be done to:

  • Find problems in the upper gastrointestinal (GI) tract. These problems can include:

  •       •Inflammation of the esophagus (esophagitis) or the stomach (gastritis)
          •Gastroesophageal reflux disease (GERD)
          •A narrowing (stricture) of the esophagus
          •Enlarged and swollen veins in the esophagus or stomach (varices)
          •Barrett's esophagus, a condition that increases the risk for developing esophageal cancer
          •Hiatal hernia
          •Ulcers
          •Cancer

  • Find the cause of vomiting blood (hematemesis)
  • Find the cause of symptoms, such as upper abdominal pain or bloating, difficulty in swallowing (dysphagia), vomiting, or unexplained weight loss
  • Find the cause of an infection
  • Check the healing of stomach ulcers
  • Look at the inside of the stomach and upper small intestine (duodenum) after surgery
  • Look for a blockage in the opening between the stomach and duodenum (gastric outlet obstruction)
  • Check for an esophageal injury in an emergency (for example, if the person has swallowed poison)
  • Collect tissue samples (biopsy) for examination in the laboratory
  • Remove growths from inside the esophagus, stomach, or small intestine (gastrointestinal polyps)
  • Treat upper gastrointestinal bleeding, including bleeding caused by engorged veins in the esophagus (esophageal varices)
  • Remove foreign objects that have been swallowed
  • Look for bleeding that may be causing a decrease in the amount of oxygen-carrying substance (hemoglobin) found in red blood cells (anemia)

Preparing for an EGD

Do not eat or drink anything for 6 to 8 hours before the test. An empty stomach helps your doctor see your stomach clearly during the test. It also reduces your chances of vomiting. If you vomit, there is a small risk that your stomach contents could enter your lungs (aspiration). If the test is done in an emergency, a tube may be inserted through your nose or mouth to empty your stomach.

If biopsy samples are taken or polyps are removed during the test, bleeding may also occur. This bleeding usually stops on its own without treatment. To reduce this risk, avoid aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) for several days before the endoscopy. If you take blood-thinning medicine, you may be instructed to stop the medicine temporarily before the test.

The Procedure

A gastrointestinal endoscopy may be done in a doctor's office, clinic or a hospital. An overnight stay in the hospital usually is not needed. The test is most often performed by a doctor who specializes in problems of the digestive system (gastroenterologist). The doctor may also have an assistant. Some family medicine doctors, internists, and surgeons are also trained to do endoscopy.

Before the procedure, blood tests may be done to check for a low blood count or clotting problems. Your throat may be numbed with an anesthetic spray, gargle, or lozenge to relax your gag reflex and make it easier to insert the endoscope into your throat.

During the test, you may receive a pain medicine and a sedative through an intravenous (IV) line in your arm or hand. These medicines reduce pain and will make you feel relaxed and drowsy during the test. You may not remember much about the actual test.

You will be asked to lie on your left side with your head bent slightly forward. A mouth guard may be placed in your mouth to protect your teeth from the endoscope. Then the lubricated tip of the endoscope will be guided into your mouth and your doctor may gently press your tongue out of the way. You may be asked to swallow to help move the tube along. It is helpful to remember that the instrument is no thicker than many foods you swallow and will not cause problems with breathing.

Once the endoscope is in your esophagus, your head will be tilted upright. This makes it easier for the scope to slide down your esophagus. During the procedure, try not to swallow unless requested to. An assistant may remove the saliva from your mouth with a suction device, or you can allow the saliva to drain from the side of your mouth.

Your doctor will slowly move the endoscope while looking through an eyepiece or watching on a video monitor to examine the walls of your esophagus, stomach, and duodenum. Air or water may be injected through the scope to help clear a path for the scope or to clear its lens, and suction may be applied to remove air or secretions.

A camera attached to the endoscope takes pictures for viewing on the monitor and stores some pictures for later study. The doctor may also insert tiny instruments (forceps, loops, swabs) through the endoscope to collect tissue samples (biopsy) or remove growths. The biopsy test is completely painless.

To make it easier for your doctor to see different parts of your upper gastrointestinal (GI) tract, you may be repositioned or have gentle pressure applied to your belly. When the examination is completed, the endoscope is slowly withdrawn.

After the Test

The test usually takes 30 to 45 minutes, but it may take longer depending upon what is found and what is done during the test.

When you are fully recovered, you can go home. You will not be able to drive or operate machinery for 12 hours after the test. Your doctor will tell you when you can resume your usual diet and activities. Do not drink alcohol for 12 to 24 hours after the test.

Complications from gastrointestinal endoscopy are rare. There is a slight risk of puncturing your throat (esophagus), stomach, or upper small intestine (duodenum). If this happens, you may need to have surgery to fix it. There is also a slight chance of infection after an endoscopy.

Bleeding may also occur from the test or if a tissue sample (biopsy) is taken, but this usually stops on its own without treatment. If you vomit during the examination and some of the material you vomit enters your lungs, aspiration pneumonia is a possible risk. If it develops, it can be treated with antibiotics.

An irregular heartbeat may occur during the test but nearly always subsides on its own without treatment.

The procedure has more risk for people with serious heart disease, older adults, and those who are frail or physically weakened. Although complications are rare, you should discuss your specific risks with your doctor.

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