Upper Endoscopy (EGD) Procedure Risks, Preparation, and Results

  • Medical Author:
    Jay W. Marks, MD

    Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

What is upper endoscopy?

Upper endoscopy is a procedure that enables the examiner (usually a gastroenterologist) to examine the esophagus (swallowing tube), stomach, and duodenum (first portion of small bowel) using a thin, flexible tube called the upper endoscope with a camera on the tip through which the lining of the esophagus, stomach, and duodenum can be viewed using a TV monitor.

How do I prepare for endoscopy?

To accomplish a safe and complete examination, the stomach should be empty. The patient will most likely be asked to have nothing to eat or drink for six hours or more prior to the procedure.

Prior to scheduling the procedure, the patient should inform his or her physician of any medications being taken, any allergies, and all known health problems. This information will help the doctor determine whether the patient may need antibiotics prior to the procedure, and what potential medications should not be used during the exam because of the patient's allergies. The information will provide the individual scheduling the procedure an opportunity to instruct the patient whether any of the medications should be held or adjusted prior to the endoscopy.

Knowledge that the patient has any major health problems, such as heart or lung diseases, will alert the doctor of possible need for special attention during the procedure.

What Are the Symptoms of GERD in Adults?

Symptoms of uncomplicated GERD include:

  • Heartburn
  • Regurgitation
  • Nausea

Symptoms and complications of GERD include:

  • Ulcers and strictures of the esophagus
  • Cough and asthma
  • Lung infections
  • Ear pain
  • A collection of fluid in the sinuses and middle ear

Why has my doctor ordered an endoscopy?

Upper endoscopy usually is performed to evaluate possible problems with the esophagus, stomach or duodenum, and evaluate symptoms such as upper abdominal pain, nausea or vomiting, difficulty in swallowing, or intestinal bleeding anemia. Upper endoscopy is more accurate than gastrointestinal X-rays for detecting inflammation or smaller abnormalities such as ulcers or tumors within the reach of the instrument. Its other major advantage over X-rays is the ability to perform biopsies (obtain small pieces of tissue) or cytology (obtain some cells with a fine brush) for microscopic examination to determine the nature of the abnormality and whether any abnormality is benign or malignant (cancerous).

Biopsies are taken for many reasons, and it may not mean that your doctor suspects cancer. Upper endoscopy also can be used to treat many conditions within its reach. The endoscope's channels permit passage of accessory instruments enabling the examiner to treat many of the conditions such as stretching areas of narrowing (strictures, Schatzki ring), removal of benign growths such as polyps, retrieving accidentally swallowed objects, or treating upper gastrointestinal bleeding, as seen in ulcers tears of the lining. These capabilities have markedly reduced the need for transfusions or surgery

What can I expect before and during the procedure? Will I be awake?

Before the procedure, the doctor will discuss with you why the procedure is being done, whether there are alternative procedures or tests, and what possible complications may result from the endoscopy.

Practices vary amongst doctors, but the patient may have the throat sprayed with a numbing solution and will probably be given sedating and pain alleviating medications through a vein. You will be relaxed after receiving this medication, usually midazolam (Versed) for sedation and fentanyl for pain relief, and you may even go to sleep. This form of sedation is called conscious sedation, and usually is administered by a nurse who monitors you during the entire procedure.

You also may be sedated using propofol (Diprivan) called "deep sedation," which usually is administered by a nurse anesthetist or anesthesiologist who monitors your vital signs (blood pressure and pulse) as well as the amount of oxygen in your blood during the procedure.

After you are sedated while lying on your left side the flexible video endoscope, the thickness of a small finger, is passed through the mouth into the esophagus, stomach, and duodenum. This procedure will NOT interfere with your breathing. Most people experience only minimal discomfort during the test, and many sleep throughout the entire procedure using conscious sedation. Deep sedation ensures that you feel no discomfort during the entire procedure.

Quick GuideHeartburn: Foods to Eat, Foods to Avoid

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What happens after the procedure? Can I drive?

When the procedure has been completed, you will be observed and monitored by a qualified individual in the endoscopy room or a recovery area until much of the effects of the medications have worn off.

Occasionally, endoscopy may cause a mild sore throat, which promptly responds to saline gargles, or a feeling of distention from the air that was used during the procedure. Both problems are mild and transient.

When fully recovered, the you will be instructed when to resume your usual diet (probably within a few hours), and the your driver will be allowed to take you home. (Because of the use of sedation, most facilities mandate that a driver take patients home and not drive, handle machinery, or make important decisions for the remainder of the day.)

What are the risks of endoscopy?

Endoscopy is a safe procedure and when performed by a physician with specialized training in these procedures, the complications are extremely rare. They may include localized irritation of the vein where the medication was administered, reaction to the medication or sedatives used, complications from pre-existing heart, lung, or liver disease, bleeding may occur at the site of a biopsy or removal of a polyp (which if it occurs is almost always minor and rarely requires transfusions or surgery). Major complications such as perforation (punching a hole through the esophagus, stomach, or duodenum) are rare but usually require surgical repair.

When will I recevie the results of my endoscopy?

Under most circumstances, the examining physician will inform the patient of the test results or the probable findings prior to discharge from the recovery area. The results of biopsies or cytology usually take 72-96 hours and the doctor may only give the patient a presumptive diagnosis pending the definitive one, after the microscopic examination of the biopsies.

What if I still have questions after the procedure?

If you have any questions or concerns about the exam, costs, whether your insurance will cover it, or methods of billing, talk to your doctor or another healthcare professional. Most endoscopists are highly trained specialists and will be happy to discuss their qualifications and answer any questions.

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Medically Reviewed on 9/19/2018
References
REFERENCE:

Yusuf, T, MD, et al. Esophagogastroduodenoscopy. Medscape. Updated: May 24, 2018.
<https://emedicine.medscape.com/article/1851864-overview>
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