Esophagogastroduodenoscopy

Indications for EGD include the following:

• Black or tarry stools or vomiting blood
• Bringing food back up (regurgitation)
• Feeling full sooner than normal or after eating less than usual
• Feeling like food is stuck behind the breastbone
• Heartburn
• Low blood count (anemia) that cannot be explained
• Pain or discomfort in the upper abdomen
• Swallowing problems or pain with swallowing
• Weight loss that cannot be explained
• Nausea or vomiting that does not go away

Your doctor may also order this test if you:

• Have cirrhosis of the liver, to look for swollen veins (called varices) in the walls of the lower part of the esophagus, which may begin to bleed
• Have Crohn disease
• Need more follow-up or treatment for a condition that has been diagnosed

The test may also be used to take a piece of tissue for biopsy.

How to prepare for the test

You will not be able to eat anything for 6 to 12 hours before the test. Follow instructions about stopping aspirin and other blood-thinning medicines before the test.

How the Test is Performed

EGD is done in a hospital or medical center. The procedure uses an endoscope. This is a flexible tube with a light and camera at the end.

The procedure is done as follows:

• You receive medicine into a vein to help you relax. You should feel no pain and not remember the procedure.
• A local anesthetic may be sprayed into your mouth to prevent you from coughing or gagging when the scope is inserted. A mouth guard is used to protect your teeth and the scope. Dentures must be removed before the procedure begins.
• You then lie on your left side.
• The scope is inserted through the esophagus (food pipe) to the stomach and duodenum. Air is put through the scope to make it easier for the doctor to see.
• The lining of the esophagus, stomach, and upper duodenum is examined. Biopsies can be taken through the scope. Biopsies are tissue samples that are looked at under the microscope.
• Different treatments may be done, such as stretching or widening a narrowed area of the esophagus.

After the test is finished, you will not be able to have food and liquid until your gag reflex returns (so you do not choke).

The test lasts about 5 to 20 minutes.

1. Arrive at least 10 minutes before the scheduled time.

2. On the morning of EGD procedure it is not allowed to:

• have breakfast and take any food, even if EGD is in the afternoon;

3. On the morning of EGD procedure it is not recommended to:

• smoke, take pills (capsules);
• On the morning of EGD procedure it is allowed to:
• brush your teeth;
• do an ultrasound examination of abdominal cavity and other organs;
• take orally disintegrating tablets;
• do injections, if it does not require a meal, and if there is no possibility to do it after EGD;

5. The night before the procedure, until 18:00 you can have an easily digestible dinner (no salads!);

• no special diet prior to EGD is required, however, take into account food digestion speed. Some foods are digested longer than usual, and they should be excluded: chocolate, alcohol, seeds, nuts, spicy food;
• if EGD is at 11 a.m. or later you may sip one glass of still water or weak tea (without jam, candy, cookies, bread, etc.)  2-3 hours before the procedure.

6. Pay attention:

• your clothing should be spacious, your collar should be unbutton, and the belt should be unbuckled;
• do not use perfume and eau de cologne;
• it is necessary to warn the physician about the patient's drug, food or other allergies.

7. The patient should bring:

• chronic medications (to take them after EGD, and orally disintegrating tablets or spray to take before the procedure if you have CAD or bronchial asthma);
• findings of previous EGD (to determine the course of disease) and biopsy (to clarify indications for re-biopsy).

8. EGD appointment card (EGD purpose, the presence of comorbidities).

Diseases diagnosed with EGD:

• Celiac disease
• Esophageal rings
• Esophageal varices (swollen veins in the lining of the esophagus caused by liver cirrhosis)
• Esophagitis (lining of the esophagus becomes inflamed or swollen)
• Gastritis (lining of the stomach and duodenum is inflamed or swollen)
• Gastroesophageal reflux disease (a condition in which food or liquid from the stomach leaks backwards into the esophagus)
• Hiatal hernia (a condition in which part of the stomach sticks up into the chest through an opening in the diaphragm)
• Mallory-Weiss syndrome (tear in the esophagus)
• Narrowing of the esophagus
• Tumors or cancer in the esophagus, stomach, or duodenum (first part of small intestine)
• Ulcers, gastric (stomach) or duodenal (small intestine)

Contraindications for EGD include the following:

• Possible perforation
• Medically unstable patients
• Unwilling patients
• Anticoagulation, pharyngeal diverticulum, or head and neck surgery (relative contraindications)