Upper GI Endoscopy = Esophago-Gastro-Duodenoscopy (EGD)

Upper gastrointestinal (GI) endoscopy is a diagnostic procedure enabling your doctor to see inside your esophagus, stomach and duodenum (the first part of the small intestine), using a flexible viewing tube – gastroscope. Gastroscope has a light and camera on the end and enables direct observing, viewing on the monitor and taking pictures or videos.

When Is Upper Endoscopy Done?

Upper endoscopy may be used to find a cause of unexplained excessive belching, nausea, vomiting, heartburn, difficulty swallowing, upper abdominal pain, anemia (due to bleeding), poor appetite or unintended weight loss. With an upper endoscopy a doctor can detect:

  • Esophageal varices (often in alcoholic liver cirrhosis)
  • Inflammation of the esophagus and damage of esophagus in acid reflux (Barret’s esophagus)
  • Hiatus hernia
  • Gastritis (chronic gastritis caused by Helycobacter pylori), gastric ulcer and cancer
  • Inflammation of the duodenum (often in celiac or Crohn’s disaese), duodenal ulcer and cancer
  • Intestinal parasites, Whipple disease, systemic sclerosis, amyloidosis

Possible therapeutic procedures during upper endoscopy:

  • Stopping of bleeding from esophageal varices or gastric or duodenal ulcer or cancer
  • Removing foreign objects
  • Removing polyps
  • Resolving (dilating) obstruction of esophagus or pylorus (an exit of the stomach)

Contraindications for Upper Endoscopy

Upper endoscopy should not be done in:

  • Suspected perforation of the esophagus, stomach or small intestine
  • Unconscious or non-cooperative patient
  • Terminal disease

How to Prepare?

Usually an upper GI series (X-ray investigation of upper GI) is performed before upper endoscopy to check for eventual obstruction or puncture that would prevent the procedure.

Few weeks before the procedure, you will have an appointment with the doctor that will perform it. The doctor will ask you about your symptoms, chronic diseases you might have, medications you take and eventual allergies. You will need to discontinue anti-rheumatic drugs like aspirin and ibuprofen, blood thinners, antidepressants, drugs for diabetes or other medication according to doctor instructions.

You will subscribe a consent with which you agree to have an upper endoscopy and declare that you are aware of its risks.

You should arrange the transport to home, since you will not be allowed to drive for 12-24 hours after the procedure (due to sedatives you will get).

You should not eat, drink (not even water), smoke or chew gum 6 hours before the procedure.

Upper Endoscopy Procedure

An upper endoscopy may be performed in hospital, an outpatient setting or office by a trained gastroenterologist ( a “stomach doctor”).

Video 1. Upper endoscopy with explanation by gastroenterologist
from American Gastrology Association (AGA)
(source: YouTube)

Anesthetic in a liquid or spray form will be given to you to prevent gag reflex. You will lie on the examination table and you will probably get a sedative medication as an injection into the vein in your arm – this will make you drowsy but you will remain conscious. During investigation you will lie on the back or on your side. Doctor will insert gastroscope through your mouth and proceed it toward duodenum and then he/she will slowly pulling it out and observing the inside of the duodenum, stomach and esophagus. If necessary, doctor will cut of few small pieces of tissue (biopsy) from the inner lining (mucosa) as samples for further investigation under the microscope. The procedure takes 20 minutes to an hour depending on what needs to be done.

How Does It Feel?

Upper endoscopy should not be painful, but can be quite uncomfortable. You may experience choking (desire to vomit). Breathing should not be affected. Procedure is usually not painful but you may experience some cramping.

You will need an hour or so to completely wake up after the procedure. You might feel nauseated or have sore throat (may persist for few days). You are allowed to eat and continue with medications right after that.

Results

If time, you will be able to discuss about results with your doctor after you wake up. Results of biopsy will be sent to you or your primary doctor within a week.

Upper endoscopy (gastroscopy) - gastric ulcer

Picture 1. Deep gastric ulcer as seen during upper endoscopy
(source: Wikipedia)

Complications

Upper GI endoscopy is generally a safe procedure. Possible complications are:

  • Perforation (puncture) of the esophagus, stomach or duodenum
  • Bleeding
  • Allergic reaction to sedatives

Contact your doctor immediately, if you will have difficulty swallowing, vomiting, fever, black stool (symptom of bleeding) or any unexplained in your upper body in days after the procedure.

Cost of Upper Endoscopy

The cost of upper endoscopy (without insurance) may range from $800 to $1,800 and depends on country, hospital, procedures performed during investigation and the cost of sedatives and anesthetics.

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Article reviewed by Dr. Greg. Last updated on December 16, 2011