Upper Endoscopy (EGD) Information | Digestive Health Associates

What is Upper Endoscopy (EGD)?

Upper endoscopy, also called EGD (EsophagoGastroDuodenoscopy) or gastroscopy, is an examination of the esophagus, stomach and duodenum (first section of the small intestine) performed by having you swallow an endoscope, usually while sedated.

The endoscope is a long, thin, flexible and steerable tube, about the diameter of a small finger, which passes easily through your mouth and throat structures following the natural food path.

Why is Upper Endoscopy Performed?

Upper endoscopy is performed to evaluate the esophagus, stomach and duodenum for a variety of disease processes which affect the interior lining of these organs, or block the normal passage of food and secretions through the upper intestines.

Common conditions we evaluate and treat include:

Gastroesophageal reflux disease (GERD)
Eosinophilic esophagitis
Esophageal infections
Helicobacter pylori gastritis (stomach infection)
Ulcers of the esophagus, stomach and duodenum
Bleeding from the upper intestinal tract
Barrett's esophagus
Esophageal strictures

Anatomy of the upper digestive tract

What to Expect

Preparation

You need to have an empty stomach. In most cases you may eat normally up until midnight on the day before your exam, after which you may continue clear liquids. No oral intake is permitted during the 4 hours before your arrival.

Arrival & Check-In

Check in at least 45 minutes before your scheduled start time for registration, changing into a gown, pre-procedure nursing assessment, IV placement, and physician assessment. Your family member or friend is welcome to stay with you during this time.

The Procedure

Once you are sedated, the doctor will pass the instrument over your tongue and into your esophagus. EGD usually takes about 10 minutes of actual procedure time. Most patients sleep through their procedure and have no recall of it.

Recovery

You'll recover briefly in your preparation area. Most patients are ready to be discharged home about 20 minutes after the procedure is completed, after reviewing the written procedure report with our nursing staff.

Common Conditions Diagnosed with Upper Endoscopy

Gastroesophageal Reflux Disease (GERD) & Hiatal Hernia

Reflux disease, also known as GERD, is the cause of common heartburn. It may also cause trouble swallowing, chest pain, asthma, cough, hoarseness and a lump sensation in the throat.

GERD results from excessive stomach fluid, which contains hydrochloric acid, bile and digestive enzymes, washing backward into the esophagus through a leaky valve at the bottom of the esophagus (incompetent lower esophageal sphincter).

Endoscopy in patients with reflux disease may be normal. Often, a hiatal hernia is evident and the lower esophageal sphincter may appear not to close tightly. In some cases damage to the esophageal lining (erosive esophagitis, ulceration) due to acid-related injury is evident.

Hiatal hernia - forward view

Hiatal hernia - retroflexed view

Hiatal hernia diagram

Severe erosive esophagitis with ulceration and early stricture formation

Barrett's Esophagus

Barrett's esophagus is a change in the lining (mucosa), usually due to reflux-related injury, from normal (squamous) to a more acid-resistant type of lining (columnar). This new lining appears endoscopically different and has particular characteristics (goblet cell metaplasia) under the microscope.

While a Barrett's type lining is less sensitive to acid injury, its presence is associated with a small future risk of esophageal cancer. The term dysplasia is used to describe changes in the Barrett's lining which may reflect progression in the direction of cancer.

Depending on the degree and extent of dysplasia, your doctor may recommend more frequent monitoring or referral to a larger center for consideration of endoscopic or surgical treatments.

Barrett's esophagus with erosion and ulceration

Swallowing Difficulties (Dysphagia)

Dysphagia is difficulty swallowing. It may result from several disease processes affecting the throat and esophagus. Upper endoscopy is most useful for evaluating and treating dysphagia arising in the esophagus, particularly when it is due to mechanical narrowing and partial blockage of the food path.

Common Causes:

1. Esophageal Strictures: Scar tissue related narrowing at the bottom of the esophagus due to acid-related injury in patients with GERD.

Esophageal stricture with ulceration

Stricture narrowing the esophageal opening

2. Eosinophilic Esophagitis (EE): Narrowing of the upper-mid esophagus due to an allergic disease of the esophagus.

Narrow "ringed" esophagus characteristic of eosinophilic esophagitis

Treatment

Strictures due to GERD are most often treated with medications such as a proton pump inhibitor (PPI) and dilation (enlargement of the narrowing), which is generally performed under sedation at the time of an endoscopy. The goal is safe and gradual enlargement, avoiding serious injury, which may necessitate several visits over the course of weeks. Medication is usually continued long term to prevent stricture recurrence.

Strictures due to EE may respond to dietary restriction or swallowed steroid treatment, but many adults presenting to our practice with EE-related dysphagia often need dilation.

Frequently Asked Questions

How will I feel after the procedure?

Most of our patients feel a little bloated, relaxed, and relieved. Many are hungry. A temporary minor sore throat is not unusual, particularly if repeated instrumentation, such as esophageal dilation, is also performed. We recommend that you eat a light meal to start with, and take it easy for a few hours. Many patients can then resume most of their activities right away, though driving should be restricted until the following day.

I have a bad gag reflex. Can I tolerate this?

Under procedural sedation the gag reflex is sufficiently suppressed to allow comfortable swallowing of the endoscope in almost every case. Patients generally have no recall of their procedure. The endoscope is of small diameter and does not interfere with your breathing when it is in place.

When do I get my results?

Your full procedure report will be completed by your gastroenterologist and provided to you by our nursing staff, who will review your findings with you at the time of discharge. If any tissue (biopsies) was removed during your examination, it will be forwarded for pathology examination. Your gastroenterologist will contact you with further information about these specimens, typically in 7-14 days.

Do I need antibiotics if I have a heart condition or artificial joint?

Heart conditions: No. The American Heart Association guidelines state that prophylactic antibiotics are not recommended for patients who undergo GI procedures, including EGD.

Artificial joints: No. The American Society for Gastrointestinal Endoscopy (ASGE) has concluded that antibiotic prophylaxis for patients with prosthetic joints is not recommended for endoscopy.

Safety & Potential Risks

While EGD provides the important health benefits of accurate diagnosis and treatment of a variety of conditions, and allows for early dysplasia and cancer detection, there are potential risks of having the procedure performed. Fortunately, for most patients the benefits easily outweigh the risks.

It is important for you to feel that this is the right procedure for you before proceeding. Your primary care provider is an excellent resource for helping you with the decision to undergo EGD. Your Digestive Health gastroenterologist will review the risks, benefits, potential complications and alternatives to EGD with you prior to your procedure.

Potential Risks

The most serious and important risks of EGD are:

The risk of missing something
The risk of perforation (rare)
The risk of bleeding
The risk of heart or lung problems related to sedation (very uncommon)

EGD performed by an experienced gastroenterologist is the most accurate means of detecting abnormalities such as Barrett's esophagus, ulcers and cancers in the upper GI tract, but no test is 100% accurate.

When to Contact Us Immediately

If you experience any unexpected symptoms after an examination, contact Digestive Health immediately:

Increasing pain in your throat, neck, chest or abdomen
Black or bloody bowel movements
Vomiting
Fever or chills

Call (970) 385-4022 - If after hours, press option 6 for our on-call doctor

Upper Endoscopy (EGD)