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Patient’s and visitor’s guide - EGD

An EGD (esophagogastroduodenoscopy) is an examination of the upper gastrointestinal (GI) tract with a special piece of equipment called an endoscope. The upper GI tract includes the throat, esophagus, stomach, and first part of the small intestines (duodenum).

An endoscope is a thin and flexible (bendable) metal tube with a light and tiny video camera on the end. The physician can either look directly in the scope or can see the pictures projected on a TV monitor. The procedure gives physicians a clear view of the esophagus, stomach, and duodenum and shows more details than pictures taken with X-ray. The endoscope also has an open channel that allows for instruments to be passed in order to take tissue samples, cauterize bleeding, or remove polyps.

Your physician will tell you the reason why an EGD has been recommended for you.

Anatomy

The digestive system helps the body digest and absorb the food we eat. Swallowed food goes through the esophagus, the feeding tube. The swallowed food then passes through the stomach where it is partially digested. Food goes from the stomach to the small intestines where nutrients are further digested and partially absorbed. The beginning of the small intestines is called the duodenum.

Risks

An EGD is a common and safe procedure. Without this procedure, diseases may not be diagnosed and proper treatment may not be given. Complications are rare, however they can occur. You need to know about them just in case they happen. These risks include:

Abdominal pain or swelling in your upper GI tract (this is due to the air that is pumped into you during the procedure and usually lasts until your body passes the extra air shortly after the procedure).
Bleedingcan occur. (This is rare, but more likely if a biopsy is performed or if the patient takes blood thinning medication. Bleeding, if it occurs, resolves on its own and in rare cases may require blood transfusion. In extreme rare cases, surgery may be needed.)
Damage to the esophagus, stomach, or duodenum (perforation) from the endoscope, which may require additional surgery to repair.
Infection.
Minor discomfort during the procedure if the local anesthetic you are given didn’t numb the area sufficiently.
Allergic reaction to the medication given for the procedure.
Complications from pre-existing diseases you may have such as heart or lung conditions.

Be sure to talk with your physician if you are worried or have questions about your procedure, medicine, or care.

Before the procedure

Your caregiver (physician or nurse) will need to know your medical and surgical history, including whether you are or could be pregnant. They will also ask you about any medications you take (prescribed, over-the counter, or other nutritional supplements) and any allergies you may have to medications or other substances. You should always carry a list of these items with you in your wallet or purse.

Depending on your current and past history, your physician may order additional tests for you. These may include blood, urine, or stool tests.

If you need a minor pain reliever in the week before the procedure, choose Acetaminophen rather than Aspirin, Ibuprofen, or Naproxen. This helps avoid extra bleeding during the procedure. If you are taking daily Aspirin for a medical condition, ask your physician if you need to stop taking it before the procedure. If you have been taking Coumadin (a blood thinner), you will have to stop it several days before the exam.

Follow your physician’s instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. For this reason, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6-8 weeks before surgery. Also, your wounds heal much better if you do not smoke after the surgery.

You should arrange to have someone be with you on the day of your procedure. If you are discharged after your EGD, you will not be able to drive home due to the medications you are given during the procedure.

You may eat meals or drink liquids that you normally have until midnight. Try to avoid eating foods with residue or fiber that are not easy to digest. These include fruits, vegetables, cereal, nuts, peas, beans, fried foods, and bread.

Follow any other instructions your healthcare provider may give you.

The day of your procedure

Do not eat or drink anything on the morning of your procedure, unless you have been instructed to do so by your physician or the nurse. This includes food, liquid, and medications. Food in the upper GI tract will block the view and hinder the examination. In addition, it can cause vomiting, creating complications. If you are instructed to take medicines, you may have them the morning of your procedure with few small sips of water.

Bring with you any papers your physician has given you to sign as well as your list of medications and allergies.

Wear loose fitting, comfortable clothing on the day of your procedure.

Informed consent: You have the right to understand your health condition in words that you know. You should be told what tests, treatments, or procedures may be done to treat your condition. Your physician should also tell you about the risks and benefits of each treatment. You will be asked to sign a consent form that gives your physician and the hospital staff permission to do certain tests, treatments, or procedures. If you are unable to give your consent, someone who has permission can sign this form for you. A consent form is a legal piece of paper that tells exactly what will be done to you. Before giving your consent, make sure all your questions have been answered so that you understand what may happen.

IV: An IV is a tube placed in your vein for giving medicine or liquids. This tube is capped or connected to tubing and liquid.

During the procedure

You will be taken on a stretcher to the Endoscopy room and then moved onto a special bed or table. The nurse will place pads on your chest to monitor your heart rate and attach a clip to your finger to monitor your oxygen levels. You will be given medication through your IV to relax and sedate you. A local anesthetic is given to help avoid gagging. This may be a spray or a medication to gargle with. It is important for you to try to relax and take slow, deep breaths through your nose. Every effort will be made to maintain your comfort and safety. Most patients sleep through the procedure. Your blood pressure, pulse, and oxygen level in your blood will be monitored. The procedure usually takes about 15 minutes to complete.
At the end of the examination, the physician will withdraw the endoscope and you will be taken to a recovery room to wait for the effect of the medications to wear off. This may take up to one hour. You will then be discharged to go home. Your physician may give you preliminary results before discharge. If any biopsy was done, these results will not be available for several days.

After your procedure

You are observed for about an hour. This is to make sure that the numbing medicine given to you has worn off and that you are able to swallow without difficulty. You may continue to feel the same discomfort or symptoms that you had before the procedure.

You may have a sore throat, bloating, or cramping. These are normal side effects and should disappear within 24 hours.

You physician will tell you how soon you can eat, drink, and resume your regular activities.

You should not eat or drink until you can cough and swallow normally.

Since you have not eaten since before midnight, you should start eating slowly after the test. Eat a light snack as your first food. You may go back to your normal activities and begin drinking and eating as soon as you feel ready.

Call your physician if

You cannot make it to your appointment on time.
You get sick (a cold or flu) or have a temperature over 101oF.
You have questions or concerns about your procedure.

Seek care immediately if

You are not able to eat or drink, or are urinating less or not at all.
You have blood in your stool.
Your abdomen becomes tender and hard.
Your signs and symptoms are getting worse.
Your vomit (throw up) has blood or bile in it.
You have problems swallowing.
You have nausea, vomiting, or sharp pain in your stomach or abdomen.
You feel dizzy, short of breath, or you feel faint.

Following your caregiver's advice during and after the procedure may decrease your chances of having any problems.