The EGD Procedure: What You Need to Know

An esophagogastroduodenoscopy (EGD) is an endoscopic procedure where a doctor places an endoscope into the mouth and advances it to the duodenum (the beginning of the small intestines). The endoscope is equipped with a light and a camera that produces a live feed of the procedure, allowing the doctor to examine the lining of the esophagus, stomach, and the first portion of the small intestine. An EGD is performed to diagnose gastrointestinal problems and to screen patients for esophageal cancer. MOT with chronic gastrointestinal symptoms can benefit from an EGD, as it will help identify a cause that can be used to develop an effective treatment plan.

An endoscope is a medical device utilized in many diagnostic procedures. It is a flexible tube that has a tiny, optically-sensitive computer chip at the end. As the doctor guides the endoscope through the upper gastrointestinal tract, it sends electronic signals to a computer that displays live images on a video screen for the doctor to see. Though an endoscope may sometimes only be used to get a closer look at the esophagus, stomach, and first portion of the small intestines, it can also help perform other functions. The open channel of the scope allows other medical instruments to be passed through it to obtain tissue samples, remove polyps, or perform other exams.

The upper gastrointestinal tract includes the mouth, esophagus, stomach, and duodenum (also known as the small bowel). This system is essential because it is used by our body to digest food, which is a primary function of life. When food enters the body through the mouth, it is carried by the esophagus to the stomach. The acid in the stomach then churns food into small particles to make them easier to digest. The food particles then enter the duodenum, where bile from the liver and digestive juices from the pancreas react with the food to help the digestive process. Both bile and enzymes are necessary for food digestion. Because the upper gastrointestinal tract serves such an important role in the body, you should address any issues as quickly as possible.

Before your procedure, you will receive instructions from your doctor about what you need to do. For the most part, the day before your EGD will be the same as any other day. It isn’t until after midnight that you need to change your routine. Be sure to tell your doctor about any medications you take or other health-related concerns, as this could alter your pre-op instructions.

Your doctor will provide you with instructions detailing what you need to do to prepare for your EGD procedure. You should not eat anything for the eight hours leading up to your appointment. In most cases, this means you should not eat after midnight on the night prior to your EGD. If you take medications, your doctor will provide information about whether you will continue to take them as usual. Most medications can still be taken before your procedure. However, if you are on blood thinners like coumadin, warfarin, Plavix, aspirin, or anti-inflammatories, your doctor may provide special instructions. This is also true for patients who have diabetes.

On the day of your EGD, we will schedule you to arrive at the endoscopy center 30 – 40 minutes before your procedure. This will allow time to fill out paperwork and prepare you for the procedure. We’ll start your IV shortly after to administer sedation medication to make you more comfortable. We will monitor your heart rate, blood pressure, pulse, breathing, and oxygen levels at all times during the appointment. Once your sedation is complete, your procedure will begin and will last between 5 to 15 minutes. You’ll then be allowed to recover fully from the sedation before being given your post-op instructions. For most patients, the sedation will wear off within 45 to 60 minutes. We’ll then release you to head home, but someone else will need to be present to drive you since the sedation can still have effects.

Though we’ve gone over the basics of what to expect on the day of your procedure, we understand you may want to know more specific details about the procedure itself. We’ve put together a complete step-by-step of what will happen during your EGD so that you can be fully prepared. You can expect your procedure to follow these steps:

• IV Sedation: After getting to the exam room, we will begin your IV sedation. The IV will be placed in your arm, and you’ll be asked to lay on your side as we begin administering the sedation medication. We’ll give you small doses of the medication periodically to ensure you don’t have any adverse reactions and that we provide only the amount you need individually, since every person is different. IV sedation works quickly, so an adequate level of sedation will be achieved in a few minutes.
• Endoscope Inserted: We’ll gently insert the endoscope into your mouth and eventually advance it through the esophagus, stomach, and the first portion of the small intestine or duodenum.
• Inspection of Upper GI Tract: As the endoscope travels along the upper GI tract, a small amount of air is injected through the scope into the tract to allow our doctor to get a clear view. Any fluid remaining in the GI tract will also be suctioned out through the scope. We’ll inspect the lining of the esophagus, stomach, and duodenum to look for any abnormalities.
• Completion of Other Medial Tasks: Depending on our findings during the procedure, there are other tasks we may complete at this time. For example, we may conduct a biopsy, remove polyps, or administer care to control bleeding.
• Removal of Endoscope: At the end of the procedure, we will suction out as much of the air and remaining fluid as possible through the scope. Depending on what we need to do during the procedure, it should last between 10 and 20 minutes.

Following your procedure, you’ll be given time to recover from the sedation. Recovery time will vary from patient to patient, but you’ll usually be awake enough to go home within an hour. You will not be permitted to drive for the rest of the day, so be sure you’ve planned for a ride. In addition, you should also not return to work, sign any important documents, or perform strenuous activities for the remainder of the day. Most patients will be able to return to normal eating and drinking habits after their discharge. Your doctor will give you more specific instructions about activity, eating, and medications before leaving our office.

Your doctor will review the findings of the procedure with you immediately following the procedure. However, many patients will not remember what they are told due to the effects of the sedation. For this reason, we recommend that you bring someone with you to the appointment with whom you feel comfortable getting the exam results. That way, this person can review the results with you after the sedation has entirely worn off. You’ll also receive a typed report for review later. If a biopsy is completed, you can expect to get the results in about a week.

While, in general, an EGD is a safe procedure, there are still risks for complications, just like in any medical procedure. Complications occur in less than one percent of patients. You can discuss any concerns with your doctor before your procedure.

• Medication Reactions: Some people can experience reactions to sedation medication. This may include an allergic reaction, difficulty breathing, effects on the heart or blood pressure, and irritation of the vein where we administered the drug.
• Bleeding: If a biopsy is performed or a polyp removed, bleeding can occur. This is usually minor. Significant bleeding that requires additional medical care is very rare.
• Other Potential Risks: While unlikely, perforation or puncture of the esophagus, stomach, or small intestine can occur. The doctor may realize this at the time of the procedure, or it may not be discovered until later. Perforation will likely require surgery and hospitalization. Be sure to contact your doctor if you experience any abdominal pain, bleeding, or fever.

In most cases, an EGD is the best method for evaluating, diagnosing, and treating any abnormalities of the upper GI tract. It gets doctors the clearest picture of the tract, so they can see any issues and accurately diagnose them. In some cases, an x-ray of the upper GI tract, known as an upper GI/barium swallow, can also allow a clear enough picture for a diagnosis. However, the x-ray is only diagnostic. Treatment of the problem will still have to be done endoscopically or through surgery.