Upper endoscopy (EGD)

The upper digestive tract consists of the esophagus, stomach and duodenum, which is where the small intestine starts. Sometimes, doctors must examine the lining of the patient's upper digestive tract. An upper endoscopy may be the best way to see these structures, as well as the gallbladder.

What is an EGD?

An upper endoscopy, also called an esophagogastroduodenoscopy (EGD), is a procedure to look at the upper digestive tract. Another term that may be used for it is gastroscopy.

During an upper endoscopy, a thin, flexible tube equipped with a light and small video camera is inserted into the patient's mouth and threaded down his or her throat into the esophagus and stomach until it reaches the small intestine.

Why patients may need an upper endoscopy

• To investigate why the patient is experiencing symptoms such as trouble swallowing, heartburn, fullness that comes on quickly, bloody vomit or cough, or unexplained weight loss
• To examine an abnormal area seen on another imaging test such as an X-ray or computed tomography (CT) scan 
• To take biopsy samples of the esophagus, stomach or small intestine, and determine whether cancer is present
• To treat a blockage in the digestive tract or other issues caused by a tumor
• To monitor how well the cancer treatment is working

Upper endoscopy prep

• Before the procedure, be sure to remove watches or other jewelry. If the patient wears dentures, they should be removed as well.
• Tell the care team about any medicines the patent takes, including vitamins, herbs and supplements, and whether the patient is allergic to any medicines.
• If the patient takes a blood thinner, he or she may be asked to stop a few days before the procedure. This includes baby aspirin.
• Don’t eat or drink for six to eight hours before the upper endoscopy.
• This test is done under a sedative to help keep the patient comfortable. Arrange for someone to drive home afterward.
• Be sure to ask questions if there’s anything confusing.

EGD procedure

The EGD procedure is typically performed as an outpatient procedure.

First, the patient's throat is sprayed with numbing medicine. Or, the patient may be asked to gargle with a liquid that numbs the throat.

Next, the patient lies on his or her left side on the examination table and is given a sedative. Some sedatives keep the patient drowsy but awake. If necessary, the doctor may perform the upper endoscopy under general anesthesia. Speak with the care team about which option is best for the patient.

A mouthpiece is placed to keep the patient's mouth open during the procedure.

The scope is guided down the patient's throat as far as the start of his or her small intestine. Doctors are able to see images of the digestive tract and to examine specific areas of concern. They can take color photographs for further review.

Sometimes, it’s necessary to pump air into the patient's stomach so the images are easier to see.

An upper endoscopy procedure takes about 15 minutes to a half hour.

The patient is observed for a while to make sure he or she is OK and until the sedative wears off. The patient should be able to go home after a few hours. In rare cases, some people may stay in the hospital overnight.

Benefits and risks of upper endoscopy

An upper endoscopy provides better detail than a CT scan or an upper gastrointestinal (GI) series, which uses X-rays.

However, there are some risks to consider. These include:

• If the patient had a biopsy as part of the procedure, he or she may experience bleeding at the site.
• The patient's mouth and throat may be numb for a couple of hours. He or she may be hoarse or cough for a couple of days afterward.
• Some people react to the sedative with breathing difficulties, low blood pressure and a slow heartbeat. Or, the patient may have a reaction to the anesthesia.
• A perforation could occur in the lining of the patient's digestive tract during the procedure and require surgery.
• The possibility of developing an infection.

If the patient has any symptoms that are unexplained, including bleeding that doesn’t stop, call the doctor’s office and ask what to do.

When to expect results

Results typically take a few days. If the patient has a biopsy during the procedure, the results may take a little longer. The samples taken need to be studied in a pathology laboratory.

The care team should follow up with the patient once the results are available. The results can help guide treatment.