Esophagogastroduodenoscopy (EGD): An Overview
Esophagogastroduodenoscopy is a diagnostic endoscopic procedure that visualizes the upper part of the gastrointestinal tract up to the duodenum. It is considered a minimally invasive procedure since it does not require an incision into one of the major body cavities and does not require any significant recovery after the procedure (unless sedation or anesthesia has been used). A sore throat is also common.
The patient is kept NPO (Nil per os) or NBM (Nothing By Mouth) that is, told not to eat, for at least 4-6 hours before the procedure. Most patients tolerate the procedure with only topical anaesthesia of the oropharynx using lidocaine spray. However, some patients may need sedation and the very anxious/agitated patient may even need a general anaesthetic. Informed consent is obtained before the procedure. The main risks are bleeding and perforation. The risk is increased when a biopsy or other intervention is performed.
The patient lies on his/her left side with the head resting comfortably on a pillow. A mouth-guard is placed between the teeth to prevent the patient from biting on the endoscope. The endoscope is then passed over the tongue and into the oropharynx. This is the most uncomfortable stage for the patient. Quick and gentle manipulation under vision guides the endoscope into the esophagus. The endoscope is gradually advanced down the esophagus making note of any pathology. Excessive insufflation of the stomach is avoided at this stage. The endoscope is quickly passed through the stomach and through the pylorus to examine the first and second parts of the duodenum.
Once this has been completed, the endoscope is withdrawn into the stomach and a more thorough examination is performed including a J-maneuver. This involves retroflexing the tip of the scope so it resembles a ‘J’ shape in order to examine the fundus and gastroesophageal junction. Any additional procedures are performed at this stage. The air in the stomach is aspirated before removing the endoscope. Still photographs can be made during the procedure and later shown to the patient to help explain any findings.