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| Esophagogastroduodenoscopy | |
|---|---|
 Endoscopic still of esophageal ulcers seen after banding ofesophageal varices, at time of esophagogastroduodenoscopy | |
| Other names | EGD OGD Upper endoscopy |
| ICD-9-CM | 45.13 |
| MeSH | D016145 |
| OPS-301 code | 1-631,1-632 |
Esophagogastroduodenoscopy (EGD) oroesophagogastroduodenoscopy (OGD), also called byvarious other names, is adiagnosticendoscopic procedure that visualizes the upper part of thegastrointestinal tract down to theduodenum. It is considered aminimally invasive procedure since it does not require anincision into one of the major body cavities and does not require any significant recovery after the procedure (unlesssedation oranesthesia has been used). However, asore throat is common.[1][2][3]
The wordsesophagogastroduodenoscopy (EGD;American English) andoesophagogastroduodenoscopy (OGD;British English; seespelling differences) are pronounced/ɪˌsɒfəɡoʊˌɡæstroʊˌd(j)uːoʊdɪˈnɒskəpi/. It is also calledpanendoscopy (PES) andupper GI endoscopy. It is also often called justupper endoscopy,upper GI, or even justendoscopy; because EGD is the most commonly performed type of endoscopy, the ambiguous termendoscopy is sometimes informally used to refer to EGD by default. The termgastroscopy literally focuses on the stomach alone, but in practice, the usage overlaps.
The complication rate is about 1 in 1000.[4] They include:
When used ininfants, the esophagogastroduodenoscope may compress thetrachealis muscle, which narrows thetrachea.[5] This can result in reduced airflow to thelungs.[5] Infants may beintubated to make sure that the trachea is fixed open.[5]
Problems of gastrointestinalfunction are usually not well diagnosed by endoscopy sincemotion orsecretion of the gastrointestinal tract is not easily inspected by EGD. Nonetheless, findings such as excess fluid or poor motion of the gut during endoscopy can be suggestive of disorders of function.Irritable bowel syndrome andfunctional dyspepsia are not diagnosed with EGD, but EGD may be helpful in excluding other diseases that mimic these common disorders.[citation needed]
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The tip of the endoscope should be lubricated and checked for critical functions including tip angulations, air and water suction, and image quality.
The patient is keptNPO (nil per os) or NBM (nothing by mouth) for at least 4 hours before the procedure. Most patients tolerate the procedure with onlytopical anesthesia of theoropharynx usinglidocaine spray. However, some patients may need sedation and the very anxious/agitated patient may even need a general anesthetic.Informed consent is obtained before the procedure. The main risks are bleeding and perforation. The risk is increased when a biopsy or other intervention is performed.
The patient lies on their left side with the head resting comfortably on a pillow. A mouth-guard is placed between the teeth to prevent the patient from biting on the endoscope. The endoscope is then passed over the tongue and into the oropharynx. This is the most uncomfortable stage for the patient. Quick and gentle manipulation under vision guides the endoscope into the esophagus. The endoscope is gradually advanced down the esophagus making note of any pathology. Excessiveinsufflation of the stomach is avoided at this stage. The endoscope is quickly passed through the stomach and through thepylorus to examine the first and second parts of theduodenum. Once this has been completed, the endoscope is withdrawn into the stomach and a more thorough examination is performed including a J-maneuver. This involves retroflexing the tip of the scope so it resembles a 'J' shape in order to examine thefundus and gastroesophageal junction. Any additional procedures are performed at this stage. The air in the stomach is aspirated before removing the endoscope. Stillphotographs can be made during the procedure and later shown to the patient to help explain any findings.
In its most basic use, the endoscope is used to inspect the internal anatomy of the digestive tract. Often inspection alone is sufficient, butbiopsy is a valuable adjunct to endoscopy. Small biopsies can be made with a pincer (biopsyforceps) which is passed through the scope and allows sampling of 1 to 3 mm pieces of tissue under direct vision. The intestinal mucosa heals quickly from such biopsies.
Clinical practice varies with respect to routine biopsy for histological analysis of the examined upper gastrointestinal system. A rapid urease test is quick, easy, and cost-effective screening for Helicobacter pylori infection.
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