What Is an EGD?

What to expect when undergoing this test

An esophagogastroduodenoscopy (EGD), often referred to as an upper endoscopy, is an invasive procedure that can help in evaluating and managing several conditions that involve the upper gastrointestinal (GI) tract— which is composed of the esophagus, stomach, and upper portion of the small intestine. Children and adults can have this procedure. Using the mouth and throat for access, a fiberoptic endoscope equipped with a camera is used to visualize your upper GI tract, obtain a biopsy, or treat gastrointestinal conditions.

what to expect during an EGD
 Illustration by Emily Roberts, Verywell

What Is EGD?

An EGD can be an intervention, a diagnostic tool, or both. With an EGD, your doctor can use a number of methods to diagnose and treat your condition.

This procedure may be part of your medical care if your doctor needs access to your upper GI tract's lumen, which is the inside of this continuous GI tube. The procedure utilizes an endoscope that is advanced from the mouth down to the GI tract. The endoscope is thin and flexible, and it has a camera and microsurgical tools attached. The camera helps your doctor see the inner lumen, while the surgical tools can be used to remove and repair defects and disease.

Your EGD may include one or more of the following components:

  • An esophagoscopy reaches inside of the esophagus.
  • A gastroscopy extends to the inside of the stomach.
  • A duodenoscopy accesses the inside of the duodenum, the first part of the small intestine.

An EGD does not visualize the upper GI system from the outside and does not provide reliable information about the lungs, liver, spleen, or other nearby organs.

Contraindications

Your doctor might recommend that you postpone your procedure if you have active esophageal bleeding or an infection in your upper GI tract, especially if it is being done as a diagnostic procedure. Sometimes cancer is a contraindication as well.

However, there are exceptions to these contraindications. If your EGD is being done for emergency treatment of bleeding, for example, then bleeding would not be a reason to postpone the procedure.

Potential Risks

Generally, complications are mild and become apparent during the procedure or within a few days. An EGD may result in serious complications, although they are uncommon.

Abrasion or a tear of the inner lining of your esophagus, stomach, or small intestine can cause bleeding. This can heal on its own if the abrasion is small. It it's larger, it can cause blood loss, and might need to be repaired during your EGD procedure or later.

The intervention can also cause a puncture in your upper GI tract, which could lead to serious bleeding or a life-threatening gastric fluid leak that would require urgent repair.

Cardiac or respiratory effects of the anesthesia are also possible, especially for people who have severe underlying heart or lung disease.

Complications are more likely if you already have a major upper GI disorder prior to the procedure, such as a bleeding ulcer or a large tumor. Additionally, a therapeutic EGD causes more tissue disruption than a diagnostic EGD and is more likely to cause complications.

Purpose of EGD

This procedure may be a beneficial therapeutic strategy when a lesion in the lumen of the upper GI tract can be treated without more extensive open surgery. As a diagnostic tool, EGD is useful when it's the easiest and safest way to obtain a biopsy.

EGD is also considered when the medical history and physical examination suggest the possibility of a lesion in the lumen that couldn't be well visualized with a less invasive test (like an imaging test).

The camera is used to view the inner lining, and your doctor might also take pictures or record a video of the region to help with diagnosis and future treatment planning.

During an EGD, your doctor may collect one or more tissue samples for a biopsy so they can be examined under a microscope. Some lesions can be treated using EGD with techniques such as tumor removal or banding (tying off) enlarged blood vessels.

Symptoms that may lead to an EGD can include:

  • Swallowing difficulties
  • Excessive or persistent vomiting
  • Hematemesis (vomiting blood) or hemoptysis (coughing up blood)
  • Heartburn
  • Excessive or unusual burping
  • A bitter taste in your mouth
  • Indigestion
  • Abdominal pain
  • Chest pain
  • Weight loss
  • Unexplained anemia (low red blood cell function)

You may also need to have an EGD if you've already had an abdominal X-ray, ultrasound, or computed tomography (CT scan) suggesting an abnormality of your upper GI tract lumen.

Medical problems that may warrant a diagnostic or therapeutic EGD include esophageal varices (enlarged blood vessels susceptible to bleeding), a peptic ulcer, and achalasia (impaired movement) of the upper GI tract.

In addition to treating lesions of the upper GI tract, EGD has also been used in the treatment of severe obesity as one of the alternatives to other types of weight loss surgery.

Typically, imaging tests can visualize the anatomic structure of the upper GI system and nearby organs, but they do not provide a view of the appearance of the inner lining itself, which makes an EDG a useful adjunct when used along with imaging tests.

How to Prepare

Before your EGD, your doctor may order imaging tests ahead of time to help plan your procedure.

Location

An EGD is typically done in an endoscopy suite, which is a special procedure room. It may be located in the hospital, a surgical center, or located in an outpatient clinic.

You should be prepared to spend several hours at your EGD appointment and to rest for the remainder of the day.

What to Wear

You will be asked to change into a gown, so you can wear whatever is comfortable. You might feel a little bloated after your procedure, so it's a good idea to bring clothes that are not restrictive on your abdominal area to wear on your way home.

Food and Drink

You will be asked to stop eating and drinking for approximately eight hours prior to your EGD. You may be permitted to drink clear liquids up to five hours prior to your appointment, and your medical team will give you more detailed instructions if there are special considerations that you need to be aware of based on your specific condition.

Medications

If you are taking blood thinners, your doctor may give you instructions to stop taking them for a few days before the test. And you might also be given instructions to adjust the dose of steroids or other anti-inflammatory medications that you might be taking.

Cost and Health Insurance

Your health insurance plan may require a pre-authorization to approve payment, and the facility where you will have the procedure will take care of that step.

You may have to pay a co-pay, and you can find out your portion of the cost from your health insurance company and the facility where you will have your procedure done.

If you are paying for your EGD out of pocket, you can expect the cost to range between $1000 and $3000.

What to Bring

You should bring your EGD order form that was given to you by your doctor, your health insurance card, a form of personal identification, and a means to pay your portion.

Because you will need to have sedation for your EGD, you should make sure that you have someone who will drive you home after the procedure.

Pre-Op Lifestyle Changes

Your doctor might advise dietary modification for several weeks prior to your EGD. For example, you might be instructed to avoid gluten if there is a concern that you could have celiac disease.

What to Expect on the Day of Your EGD

When you check-in for your EGD, you will be asked to fill out some forms, including a consent form, authorization for payment, and a patient privacy form.

An EGD is usually performed by a gastroenterologist, a physician specialized in treating diseases of the gastrointestinal system. A nurse or technician will assist with the procedure.

Before the Procedure

You will be led to the procedure room, and you will change into a gown. Your heart rate, blood pressure, respiratory rate, and oxygen level will be monitored throughout your procedure.

You will need to have intravenous (IV) sedation as well as local numbing medicine administered to your throat to prevent discomfort and gagging.

A nurse will place an IV line in your hand or arm; you should feel an initial pinch, but no pain thereafter. The IV medication will then be injected, which will make you sleepy and relaxed. While the drug itself won't put you to sleep, it's not uncommon to fall asleep during this procedure.

If you have them, dentures or partial plates will be removed so the numbing medicine can reach all areas of the mouth and to avoid damage from the endoscope. Your throat will then be sprayed with the medicine, which will have a numbing effect for about 30 to 45 minutes.

You will be given a protective device to put into in your mouth to protect your teeth from the endoscope and then you will be positioned so that you lie on your left side.

During the Procedure

When you are properly relaxed, you will be asked to swallow once or twice during the initial period of insertion of the endoscope. The tube will not interfere with your ability to breathe and is only mildly uncomfortable following the initial insertion.

You should not feel any discomfort during your EGD, and you shouldn't be able to feel any pain or notice incisions from techniques such as a biopsy or tumor resection.

You may experience a feeling of fullness in your abdomen as the doctor injects a moderate amount of air to expand your stomach, allowing for better visualization. Pictures or videos may be taken of the inside of your digestive tract to monitor abnormalities and for treatment planning.

If you are having your EGD for treatment of a gastrointestinal condition, electrosurgical instruments attached to the endoscope will be used.

A biopsy may be taken for examination. You will have stitches placed in the wound to stop bleeding and hasten healing after a biopsy.

There is a wide variety of methods used for each of the different conditions that can be treated with an EGD. For example, your doctor might cut away a growth (like cancer), repair an open lesion (like an ulcer), tie off esophageal varices, use heat or cold to destroy an abscess, or use a balloon device or laser therapy for dilatation (widening) your upper GI tract.

You might have diagnostic and therapeutic aspects of your EGD. And your doctor may decide on some therapeutic approaches during your procedure based on the observations made while you are having your EGD.

After the Procedure

After the endoscope is removed, your medical team will let you know that your procedure is complete. You may not recall the procedure because of the effect of the sedation.

You will need to recover and wait until you are awake and alert before being discharged to home. In the meantime, you might have vital signs like your blood pressure and pulse monitored as you are waking up and recovering.

Be sure to let your medical team know if you have discomfort or pain.

Your doctor will tell you when you will be able to eat or drink following the procedure. You may receive your results the same day or have to wait several days or weeks to discuss them with your doctor.

Recovery

You should expect to feel groggy for several hours after your EGD. You may have a slightly sore throat after the procedure, which should last for approximately 24 hours. It is best to take it easy and avoid eating or drinking extremely hot or spicy foods and drinks for the rest of the day.

Healing

Recovery from the endoscopy should take no more than a few days. If your throat discomfort lasts for longer than a few days, if you experience worsening pain or trouble swallowing, or if you develop swelling in the back of your throat, call your doctor.

Get emergency medical attention if you develop unusual or severe abdominal pain or bleeding following the procedure. Dark-colored stools or coughing, spitting, or vomiting blood are signs to watch for. Lightheadedness or dizziness can signal severe blood loss and also requires urgent medical attention.

Coping With Recovery

As you recover, it's a good idea to eat or drink slowly. Cool fluids and soft foods are best. Advance your diet slowly and don't push yourself to eat more than you can handle too soon. You should be able to tolerate regular food within a week.

Long Term Care

You shouldn't need long term care because of an EGD procedure specifically. But you may need treatments to manage issues that are detected during an EGD.

Your doctor will either discuss the results with you immediately after your test or may schedule another appointment to discuss the result and a plan, especially if your test involved a biopsy.

Conditions that may be diagnosed with the aid of EGD include:

  • Narrowing of areas of the GI tract
  • Ulcerations
  • Hiatal hernia
  • Enlarged blood vessels and esophageal varices
  • Inflammation
  • Chronic diseases such as celiac disease or Crohn's disease
  • Infections
  • Cancer

Depending on your test results, you may need to have treatment for a medical problem.

Treatments might include chemotherapy and radiation therapy for cancer, surgery for a hernia, or anti-inflammatory medication for Crohn's disease.

Possible Future Surgeries

In general, you should not need to have EGD procedures routinely repeated, but if your symptoms unexpectedly worsen, or if you develop new symptoms, your doctors may want you to have another EGD to investigate the cause.

Lifestyle Adjustments

Depending on your condition, you might have to make some dietary changes. For example, your doctor or a dietitian may recommend avoiding acidic foods that exacerbate an ulcer. Or you might need to limit your meals to small amounts if you have a chronic problem with upper GI constriction.

And if you've had an EGD for treatment of obesity, you will need to limit calories to maintain the benefits long term.

Keep in mind that each GI condition is managed by its own special diet, and this is not a one-size-fits-all strategy.

A Word From Verywell

An EGD can be an important part of the diagnosis and management of diseases of the upper GI tract. The procedure is generally well tolerated with a recovery that doesn't normally take longer than a few days.

If you have a short term or chronic upper GI condition that requires an EGD, don't hesitate to ask your doctor and your medical team to explain the results of your EGD so you can understand what is going on with your health.

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