Upper Endoscopy (also known as gastroscopy, EGD, or esophagogastroduodenoscopy) is a procedure that enables your doctor to examine the lining of the esophagus (swallowing tube), stomach and duodenum (first portion of the small intestine). A flexible, lighted tube about the thickness of your little finger is placed through your mouth and into the stomach and duodenum.
Why Do An Upper Endoscopy?
Upper endoscopy is performed to evaluate symptoms of persistent upper abdominal pain, nausea, vomiting, difficulty swallowing or heartburn. It is an excellent method for finding the cause of bleeding from the upper gastrointestinal tract. It is more accurate than X-rays for detecting inflammation, ulcers or tumors of the esophagus, stomach and duodenum. Upper endoscopy can detect early cancer and can distinguish between cancerous and non-cancerous conditions by performing biopsies of suspicious areas. These are then sent to the laboratory to be analyzed. A biopsy is taken for many reasons and does not mean that cancer is suspected.
What Preparation Is Required?
The stomach should be completely empty. You should have nothing to eat or drink after midnight prior to the day before the examination. Your doctor will be more specific about the time to begin fasting depending on the time of day that your test is scheduled.
Medication may need to be adjusted or avoided. It is therefore best to inform your doctor of ALL your current medications as well as allergies to medications a few days prior to the examination. Also, if you have a medical condition, such as heart or lung disease that may require special attention during the procedure, discuss this with your doctor.
You will most likely be sedated during the procedure and arrangements to have someone accompany you home afterward is imperative. Sedatives will affect your judgment and reflexes for the rest of the day. You should not drive or operate machinery until the next day.
Will the Procedure Hurt?
Your physician or a Certified Nurse Anesthetist (CRNA), under the supervision of an Anesthesiologist, will give you an intravenous medication to make you feel relaxed. Some people fall asleep and do not remember the procedure when they awaken. The physician will put air into your stomach to help visualize the lining and this sometimes causes a cramping or bloated sensation.
What Can I Expect When I Arrive at the Endoscopy Center?
When you arrive at the endoscopy center, you will be asked to change into a gown. The nurse and/or an Anesthesiologist will ask you questions about your medical history and current medication use. Updating this information will make the procedure safe for you. Please be prepared to review your health history at this time. Bring a list of medications and drug allergies, if necessary. Your blood pressure, pulse rate, and oxygen saturation will be monitored before, during and after the exam. An intravenous (I.V.) needle will be placed in your hand or arm.
What Can I Expect During the Upper Endoscopy?
The nurse will help you get comfortable on a stretcher. After blood pressure and heart rate monitors are applied you will lie on your left side. Your physician or Certified Nurse Anesthetist (CRNA) will give you an intravenous injection of medication. After you become relaxed, the physician will insert the tip of the scope into your mouth and advance it forward into the duodenum. The procedure takes 20-45 minutes. When your exam is finished you will be taken to the recovery room for observation.
What Happens After Upper Endoscopy?
You will be monitored in the recovery area for about 20-30 minutes until the effects of the sedatives have worn off. Your throat may be a little sore for a day or two. You may feel bloated immediately after the procedure because of the air that is introduced into your stomach during the examination. You will be able to resume your diet and take your routine medication after you leave the endoscopy center, unless otherwise instructed. Your doctor will usually inform you of your test results on the day of the procedure, unless biopsy samples were taken. These results take about 5 days to return.
The sedation used during your exam impairs judgment, memory, and equilibrium. We cannot perform this procedure unless we know that you will arrive home safely, so please bring a friend or family member with you:
Do not drive, operate machinery, make critical decisions, drink alcoholic beverages, or do activities that require coordination or balance for 24 hours.
If given medication for pain, take it, as instructed, so your pain is not overwhelming.
You may experience a sore throat for 24 to 48 hours. You may use throat lozenges or gargle with warm water to relieve the discomfort.
Because air was put into your stomach during the procedure, you may experience some belching.
What Complications Can Occur?
Gastroscopy and biopsy are very safe when performed by doctors who have had special training and are experienced in these endoscopic procedures. Complications are rare. However, they can occur and include bleeding from the site of a biopsy or polypectomy and a tear (perforation) through the lining of the intestinal wall. Blood transfusions are rarely required. A reaction to the sedatives can occur. Irritation to the vein that medications were given is uncommon, but may cause a tender lump lasting a few weeks. Warm, moist towels will help relieve this discomfort.
When performed by a knowledgeable and competent physician, an Upper Endoscopy (EGD) is a very low risk procedure. Very rarely, bleeding or perforation (tearing of the lining of the colon) may occur. Other risks include a reaction to medication, irritation at the site of the injection, or complications related to other medical problems that you may already have.
Perforation: Passage of the instrument may result in an injury to the gastrointestinal tract wall with possible leakage of gastrointestinal contents into the body cavity. If this occurs, surgery to close the leak and/or drain the region is usually required.
Bleeding: Bleeding, if it occurs, is usually a complication of biopsy, Polypectomy or dilation. Management of this complication may consist only of careful observation, or may require transfusions or possibly a surgical operation.
Medication Phlebitis: Medications used for sedation may irritate the vein in which they are injected. This causes a red, painful swelling of the vein and surrounding tissue. The area could become infected. Discomfort in the area may persist for several weeks to several months.
Conscious Sedation Medication and Pregnancy: There are risks involved with Anesthesia, especially as it relates to a pregnancy. If there is a question that a pregnancy is possible, a urine pregnancy test will be performed prior to the procedure. If you are breast feeding, do not breast feed for 48 hours.
Other Risks: Include drug reactions and complications from other diseases you may already have. Instrument failure and death are extremely rare but remain remote possibilities.
YOU MUST INFORM YOUR PHYSICIAN OF ALL YOUR ALLERGIC TENDENCIES AND MEDICAL PROBLEMS.
Although complications after Upper Endoscopy (EGD) are uncommon, it is important for you to recognize early signs of any possible complication. Go directly to the emergency room and contact your physician if you notice any of the following:
• Chills and/or fever over 101
• Persistent vomiting or vomiting with blood/nasal regurgitation
• Severe abdominal pain, other than gas cramps
Severe chest pain
• Black, tarry stools
Please be informed that an EGD is never 100% accurate. After the procedure, if you should develop any new or recurrent gastrointestinal signs or symptoms, immediately bring it to the attention of your Physician.
What are the Alternatives to Gastrointestinal Endoscopy?
Although gastrointestinal endoscopy is an extremely safe and effective means of examining the gastrointestinal tract, it is not 100 percent accurate in diagnosis. In a small percentage of cases, a failure of diagnosis or misdiagnosis may result. Other diagnostic or therapeutic procedures, such as medical treatment, x-ray and surgery are available. Another option is to choose no diagnostic studies and/or treatment. Your physician will be happy to discuss these options with you.