General Information
Upper Endoscopy is also known as an EGD (esophagogastroduodenoscopy). This procedure uses a fiber optic instrument that is placed into the stomach after intravenous analgesics have been administered. Thus, with the fiber optic scopes, a visual evaluation of the upper gastrointestinal tract can be done. The areas studied with this test are the esophagus, the stomach and the upper duodenum.
Indications
EGD is used to diagnose and treat a variety of conditions. These include GERD, gastric and duodenal ulcers, esophageal varices, stomach polyps, and Helicobacter Pylori.
Other Methods for Evaluation
Since this is visual inspection of the upper gastrointestinal tract, fine detail can be identified which might be missed by other techniques. However, alternative methods to assessing the upper gastrointestinal tract include an UGI series (barium is swallowed and evaluated with radiographs by a radiologist), blood work, CT scans of the chest and upper abdomen and ultrasound of the abdomen. Many of these tests are useful in a complimentary way to your physician. As in all aspects of medicine, no one test will completely evaluate a problem.
The Procedure
In general, this procedure takes approximately 15 to 30 minutes to perform when done by a trained gastroenterologist. The procedure may take longer depending upon the intervention that may be required for any individual patient.
Patients undergoing this procedure usually receive a combination of intravenous anesthetics. These are usually Demerol ( meperidine), Versed (midazolam) or Fentanyl. The exact combination, dose and frequency of each of these are individualized for each patient. In most cases, patients do not remember their procedure, or, are adequately sedated such that the discomfort is well tolerated.
During the procedure, the nurse assisting your physician with the procedure will continuously monitor your heart rate, oxygen saturation and blood pressure. Thus, should any difficulties with these parameters occur, your physician will be aware of the change quickly.
Risks associated with the procedure
The risks to this procedure are:
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Allergic reaction to the medications used in sedation |
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Perforation of the esophagus, stomach or duodenum |
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Bleeding |
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Aspiration Pneumonia (breathing in stomach contents during the procedure) |
Before the Test (Preparation)
The preparation for this procedure is rather easy. It is recommended that patients do not eat or drink anything after midnight prior to the procedure. This will minimize the possibility that a patient will develop an aspiration pneumonia.
You should inform your physician regarding the medication you are taking. Usually, patients who are taking insulin for diabetes should have half their regular dose of insulin. Every attempt is made to have the procedure done early in the morning. Please make sure that your physician knows well beforehand if you are taking any blood thinners. Specific instructions regarding the preparation are available in the section regarding preparations for procedures.
After the Test (Post Procedure or Recovery)
After the procedure, the physician will discuss the results with the family and/or the patient. In many cases, the patient will not recall having talked with their physician. This is a natural and understandable, event since some medications used during the procedure will induce a temporary amnesia.
After the procedure, patients are returned to a recovery area where they are monitored during their stay. When the patient is stable, he or she will be discharged.
Patients must have someone to drive him or her home after conscious sedation (analgesics) have been administered.
Most patients will be lethargic and forgetful during the afternoon after the procedure. During this period of time, someone should be available to check in the with patient insure their safety. No driving, complicated or important decisions or alcoholic beverages are allowed on the day of the procedure. By the next morning, most patient are able to continue with their daily activities.
To assist our patients, a written explanation of the procedure and its findings, in lay terms, will be given to the patient. Recommendations will be made regarding any further testing, treatments or office visits.
A copy of the endoscopic record is sent to all our referring physicians. Thus, your primary care physician will be aware of your procedure, the results and your gastroenterologist's recommendations.
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