EGD (Upper GI Endoscopy)
Upper endoscopy is a commonly performed procedure designed to examine the upper gastrointestinal (GI) tract. The upper GI tract consists of the esophagus, stomach, and duodenum (the first foot of the 22-foot long small intestine). Upper endoscopy is also known as esophago-gastro-duodenoscopy, which is commonly referred to as an EGD. This procedure is done to examine, diagnose, or treat conditions such as: inflammations of the esophagus (esophagitis), Barrett’s esophagus (intestinal lining of the esophagus instead of the usual esophageal lining), hiatal hernias, strictures, rings or tumors of the esophagus, stomach, or duodenum, or ulcers of the stomach or duodenum. During the procedure if your doctor sees that the esophagus has become narrow due to an underlying medical condition, a procedure called dilation is performed to carefully, albeit temporarily, expand the diameter of the esophagus in order to ease swallowing difficulties.
EGD is performed with a 110cm (3.6 foot) long, thin (the diameter of your little finger) flexible video fiberoptic scope. It is inserted though the mouth and passed under direct visualization through the esophagus, stomach, and duodenum. There are one or two channels in the upper endoscope to allow for the introduction or removal of air into the upper GI tract and for the introduction of biopsy forceps or other instruments.
The procedure typically takes 10 to15 minutes to complete and is usually performed under some form of intravenous sedation. Sometimes a numbing throat spray is used. EGD is not a painful procedure, but does require sedation to overcome the gag reflex. If the lining of any of the visualized organs is abnormal, a biopsy and photograph may be taken to document the abnormality. EGD can be used either as a diagnostic test or therapy, such as with esophageal dilation. Polyps of the stomach can be removed or destroyed using coagulation probes. Various instruments can be safely introduced through the scope to stop internal bleeding caused by ulcers or bleeding veins or arterioles. These might involve injecting the ulcers with medications to stop bleeding or applying thermal techniques to the ulcers to coagulate blood vessels.
Although EGD is a highly accurate procedure to diagnose diseases of the esophagus, stomach and duodenum, it is not a perfect test. There is a small miss rate of significant findings with this procedure.
EGD is a very safe procedure, however, there are uncommon risks to the procedure. While we have discussed these and possibly others in your consultation, we would like you to have a list so that you may ask questions if you are still concerned. Aside from anesthesia complications, it is important that every patient be made aware of possible outcomes that may include, but are not limited to:
- Perforation (puncturing) of the esophagus, stomach or duodenum: The most serious risk of this procedure is perforation (puncturing) of the esophagus, stomach or duodenum. The risk is increased if an esophageal dilation is performed. The symptoms of perforation are severe chest or abdominal pain after the procedure. Air under the skin (which causes a crackly sensation when pressing on the skin) may be present. The diagnosis is made by a plain x-ray, CT scan of the abdomen or chest, or gastrografin swallow. Small perforations can be treated by hospitalization and watchful waiting, but sometimes urgent or semi-urgent surgery is needed to close the perforation.
- Apiration of gastric fluid into the lung: Another rare risk is aspiration of stomach fluid into the lungs. This occurs if a patient were to vomit during the procedure and the fluid pass down the wrong passage into the lungs causing a pneumonia. Precautions that are routinely performed during upper endoscopy prevent this from happening include positioning the patient on the left side and suctioning the contents of the mouth frequently.
- Internal bleeding: Another unusual risk is internal bleeding if a biopsy is taken or a polyp is removed. Bleeding can occur immediately after the procedure or be delayed for hours or days. If your physician does remove a polyp you should not take aspirin or other anti-inflammatory medications for a week. Tylenol or acetaminophen is ok.
- Over-sedation: While rare, over sedation is a risk. Sedation can depress respiration and blood pressure. Your physician will be carefully monitoring your vital signs during the procedure and administering sedation slowly to prevent this from occurring.
- Death: Death from an EGD is a very remote possibility, but, has occurred even when procedure was done by experienced gastroenterologists due to known and unknown risks.