Oesophagogastroscopy

Oesophagogastroscopy, also called upper endoscopy or EGD, is a medical procedure that allows doctors to examine the inside of your upper digestive system using a flexible tube with a camera. This procedure helps diagnose and sometimes treat various digestive problems affecting your esophagus, stomach, and the beginning of your small intestine.

Table of contents

• What is oesophagogastroscopy?
• Parts of the body examined
• When you might need this procedure
• Conditions this procedure can diagnose
• What this procedure can treat
• How to prepare for the procedure
• What happens during the procedure
• After the procedure
• Risks and contraindications

What is oesophagogastroscopy?

Oesophagogastroscopy is a test to examine the lining of the esophagus (the tube that carries food from your mouth to your stomach), stomach, and the first part of the small intestine called the duodenum^[1]. The medical term “oesophagogastroduodenoscopy” can be broken down into parts: “esophago-” means esophagus, “gastro-” means stomach, “duodeno-” means duodenum, and “-scopy” means an examination with a visual instrument^[1].

The procedure is performed by a specialist in diseases of the digestive system called a gastroenterologist^[4]. During the test, the doctor uses a special instrument called an endoscope, which is a thin, flexible tube with a light and camera on the end^[2]. The camera sends images to a computer screen, allowing the doctor to see inside your upper digestive system clearly^[1].

This is one of the most common procedures that gastroenterologists perform^[3]. The procedure can be done in a hospital, an outpatient center, or in your healthcare provider’s office^[4].

EGD, upper endoscopy, upper GI endoscopy, esophagogastroduodenoscopy, gastroscopy, upper gastrointestinal endoscopy

Parts of the body examined

• Oropharynx (mouth and throat area)
• Esophagus
• Stomach
• Duodenum (first part of small intestine)

The esophagus is located behind the windpipe and begins just below the voice box area. It ranges in length from about 9 to 10 cm in infants to approximately 25 cm in adults^[3]. The change in color from pale to reddish-pink marks the transition from the esophagus to the stomach lining, which doctors call the Z line^[3].

The stomach is usually located beneath the diaphragm (the muscle that separates your chest from your abdomen) and is approximately 40 cm from your front teeth in an adult^[3]. The area where the esophagus enters the stomach is called the gastric cardia. The upper portion of the stomach is called the fundus, and the largest part is called the stomach body. The pylorus is the muscular opening between the lower end of the stomach and the duodenum^[3].

The duodenum extends from the pylorus and forms a C-shaped loop. The duodenum bulb is an expanded region immediately beyond the pylorus^[3].

When you might need this procedure

Your healthcare provider may recommend an upper endoscopy if you have unexplained symptoms affecting your digestive system^[1]. You may need this test if you experience:

• Persistent pain or discomfort in the upper abdomen^[2]
• Heartburn or acid reflux that doesn’t respond to treatment^[1]
• Difficulty swallowing or pain when swallowing^[2]
• Nausea and vomiting that doesn’t go away^[2]
• Unexplained weight loss^[1]
• Vomiting blood or passing black, tarry stools^[2]
• Feeling full sooner than normal or after eating less than usual^[2]
• Feeling like food is stuck behind the breastbone^[2]
• Unexplained anemia (low blood count)^[2]
• Non-cardiac chest pain (chest pain not related to the heart)^[1]

Your healthcare provider may also order this test if you have cirrhosis of the liver (scarring of the liver) to look for swollen veins in the walls of the lower part of the esophagus, which may begin to bleed^[2]. The test may also be needed for follow-up or treatment of a condition that has already been diagnosed^[2].

Conditions this procedure can diagnose

An upper endoscopy provides a direct view into your upper digestive system and can be more accurate than X-rays in diagnosing problems^[1]. The conditions that can be diagnosed include:

• Acid reflux (gastroesophageal reflux disease or GERD) – a condition in which food or liquid from the stomach leaks backward into the esophagus^[1]
• Esophagitis – inflammation or swelling of the lining of the esophagus^[2]
• Gastritis – inflammation or swelling of the lining of the stomach^[2]
• Duodenitis – inflammation of the duodenum^[1]
• Stomach ulcers (peptic ulcers) – sores in the lining of the stomach or duodenum^[1]
• Celiac disease – damage to the lining of the small intestine from a reaction to eating gluten^[2]
• Crohn’s disease – an inflammatory bowel disease^[2]
• Barrett’s esophagus – a condition where the lining of the esophagus changes^[1]
• Hiatal hernia – a condition in which part of the stomach pushes up through the diaphragm^[2]
• Esophageal varices – swollen veins in the lining of the esophagus caused by liver cirrhosis^[2]
• Portal hypertension – high blood pressure in the veins that bring blood to the liver^[1]
• Intestinal metaplasia – abnormal changes in the intestinal lining^[1]
• Swallowing disorders^[1]
• Cancerous and noncancerous tumors^[1]

During the procedure, the doctor can also take a tissue sample called a biopsy to examine under the microscope for signs of disease^[2]. This helps in making an accurate diagnosis.

What this procedure can treat

Healthcare providers can also perform treatments during an endoscopy^[1]. By attaching tiny tools to the endoscope, doctors can often fix small problems on the spot. These treatments include:

• Repairing holes in the digestive tract^[1]
• Draining abscesses (collections of pus)^[1]
• Opening narrowed passages or stretching areas that have become narrow^[1]
• Inserting medical devices for therapy^[1]
• Managing upper digestive tract bleeding^[1]
• Removing polyps (growths), tumors, or swallowed objects^[1]

How to prepare for the procedure

An upper endoscopy is a simple outpatient procedure that usually takes about 5 to 20 minutes to complete^[2], but you should expect to be at the medical facility for a few hours to allow time for preparation and recovery^[4]. Proper preparation is important to ensure the procedure goes smoothly and safely. Here’s what you need to do:

Fasting: You will need to avoid eating anything for 6 to 12 hours before the test^[2]. This is essential to avoid complications from food that may still be in your stomach during the procedure^[1]. An empty stomach helps your doctor see your stomach clearly and reduces your chances of vomiting^[8]. You can drink clear liquids up to two hours before the test^[1].

Medications: Tell your doctor about all the medicines and natural health products you take^[2]. Some medications can increase the risk of bleeding during the procedure, including anti-inflammatory medicines, blood thinners like warfarin, heparin, and aspirin^[2]. You may need to stop taking blood thinners and adjust your diabetes medications the day before the test^[1]. Your healthcare provider will give you specific instructions about which medications to stop or adjust. Never stop or change your medication without consulting your doctor first.

Medical consultation: Before the procedure, you will have a consultation with your healthcare provider^[1]. Tell your doctor if you are pregnant or have any health conditions, such as heart disease or cancer^[1]. This information helps your doctor take necessary precautions to perform the procedure as safely as possible. Also inform your doctor about any allergies you have.

Transportation: Since sedation is usually administered during the procedure, you will not be allowed to drive yourself home afterward^[1]. Arrange for a friend or family member to provide transportation home.

Clothing and personal items: Wear loose, comfortable clothing on the day of the procedure^[1]. Take off all jewelry and piercings, and take out contact lenses if you wear them. Do not apply lotions, perfumes, deodorants, or nail polish.

What happens during the procedure

The upper endoscopy is performed in a hospital or outpatient center by a specially trained gastroenterologist^[2]. Here’s what happens during the procedure:

Before starting: During the procedure, your breathing, heart rate, blood pressure, and oxygen level are monitored^[2]. Wires are attached to certain areas of your body and then to machines that monitor these vital signs.

Sedation and numbing: You will receive medicine into a vein to help you relax. You should feel no pain and may not remember the procedure^[2]. A local anesthetic spray may be applied to your mouth and throat to numb it and prevent you from coughing or gagging when the scope is inserted^[2]. The spray might taste a bit unpleasant. Some patients may receive deeper sedation or general anesthesia depending on their needs.

Positioning: A mouth guard is placed to protect your teeth and the scope^[2]. Dentures must be removed before the procedure begins. You will then lie on your left side or back^[2].

Inserting the endoscope: The doctor will gently insert the scope through your mouth and toward the back of your throat^[2]. You will be told when to swallow, which helps the scope move down your throat. You will be able to breathe normally during the procedure. The doctor will move the scope down your esophagus into your stomach and then into your duodenum. You might feel a slight gagging sensation, but this will pass quickly.

Examination: Air is put through the scope to make it easier for your doctor to see^[2]. The doctor examines the lining of your esophagus, stomach, and upper duodenum. You may feel bloated from the air, but this feeling soon wears off^[2]. You may feel gas and the movement of the scope in your abdomen, but because of sedation, you may not feel any discomfort and have no memory of the test^[2].

Biopsy or treatment: If the doctor wants to take a tissue sample for biopsy or perform a treatment, small surgical tools are inserted through the scope^[2]. You will not feel a biopsy if one is taken.

The actual examination usually takes only 5 to 10 minutes, though the entire appointment may take longer.

After the procedure

After the upper endoscopy is finished, you will not be able to have food and liquid until your gag reflex returns, which helps prevent choking^[2]. This usually takes a short time.

You will be taken to a recovery area where you will be monitored until the sedative wears off^[1]. It’s important to rest for the remainder of the day. Avoid activities like driving or making important decisions, as the effects of sedation may linger.

You might experience mild throat discomfort or bloating due to the air introduced during the procedure^[2]. These symptoms are usually temporary and wear off shortly. You may also feel a bit drowsy after the procedure.

Your healthcare provider will discuss the findings of the endoscopy with you and may recommend additional tests or treatments if necessary^[1]. Having a friend or family member with you during this discussion is advisable, especially if you had sedation.

Follow any instructions you’re given for recovering at home^[2]. You should be able to return to your normal activities the next day in most cases.

Risks and contraindications

Risks: Complications from upper endoscopy are rare, but they can occur. Possible complications include:

• Aspiration – when food or liquid gets into the lungs. This can happen if you eat or drink before the procedure, which is why fasting is so important^[2]
• Bleeding – this risk is higher with certain therapeutic procedures^[7]
• Perforation (a tear in the digestive tract) – this is very rare^[7]
• Reactions to sedation^[7]

Contraindications: There are situations where an upper endoscopy may not be appropriate or may need to be delayed:

• Possible perforation of the digestive tract^[7]
• Medically unstable patients^[7]
• Patients who are unwilling to undergo the procedure^[7]

There are also relative contraindications, which means the procedure might still be done but with extra caution. These include problems with anticoagulation (blood thinning), having a pouch in the throat, or recent head and neck surgery^[7].

Diagnostic upper endoscopy is considered a low-risk procedure for bleeding in patients on anticoagulants and can often be performed without adjusting these medications beforehand^[7]. However, if certain treatments are planned during the procedure, such as removing polyps, then blood-thinning medications may need to be adjusted.

It’s important to discuss all risks and benefits with your healthcare provider before the procedure to understand what to expect.