Tuesday, June 15, 2010

What is an esophagogastroduodenoscopy? How treatement is given and involvement of risk

Esophagogastroduodenoscopy - Overview (EGD, Upper Gastrointestinal Endoscopy, Upper GI Endoscopy, Gastroscopy, Esophagoscopy)

What is an esophagogastroduodenoscopy?

Esophagogastroduodenoscopy (EGD) is a diagnostic procedure that allows the physician to diagnose and treat problems in the upper gastrointestinal (UGI) tract. The physician uses a long, flexible, lighted tube called an endoscope. The endoscope is guided through the patient's mouth and throat, then through the esophagus, stomach, and duodenum (first part of the small intestine). The physician can examine the inside of these organs and detect abnormalities.

In addition to performing visual examination of the UGI tract with the endoscope, the physician can insert instruments through the endoscope to obtain tissue samples for a biopsy, remove foreign objects, instill air or fluid, stop bleeding, or perform therapeutic procedures, such as endoscopic surgery, laser therapy, or dilatation (opening up). A video camera in the endoscope provides images onto a TV-like monitor.
Other related procedures that may be used to diagnose upper gastrointestinal problems are barium swallow and upper gastrointestinal series. Please see these procedures for additional information.
About the upper GI tract:

Digestion is the process by which food and liquid are broken down into smaller parts so that the body can use them to build and nourish cells, and to provide energy. Digestion begins in the mouth, where food and liquids are taken in, and is completed in the small intestine.
Digestion involves the mixing of food, the movement of food through the digestive tract, and the chemical breakdown of large molecules of food into smaller molecules.
In a wave-like movement, called peristalsis, muscles propel food and liquid along the digestive tract. The involvement of the upper GI tract includes the following:
  • The first major muscle movement is swallowing food or liquid. The start of swallowing is voluntary, but once it begins, the process becomes involuntary and continues under the control of the nerves.
  • The esophagus, which connects the throat above with the stomach below, is the first organ into which the swallowed food goes.
  • Where the esophagus and stomach join, there is a ring-like valve that closes the passage between the two organs. As food nears the valve, the surrounding muscles relax and allow food to pass into the stomach. The valve then closes.
  • The food then enters the stomach, which completes three mechanical tasks of storing and mixing the food, then emptying it into the small intestine.
  • The food is digested in the small intestine and dissolved by the juices from the pancreas, liver, and intestine and the contents of the intestine are mixed and pushed forward to allow further digestion.

    Reasons for the Procedure

    An EGD may be performed to diagnose structural or functional abnormalities of the esophagus, stomach, and/or duodenum. These abnormalities may include, but are not limited to, the following:
  • dysphagia (difficulty swallowing)
  • weight loss or anorexia (loss of appetite)
  • upper abdominal pain or chest pain of a noncardiac origin
  • gastroesophageal reflux disease (GERD)
  • intractable vomiting (continuous vomiting from an unknown cause)
  • strictures (narrowing) or obstructions
  • gastrointestinal bleeding and esophageal varices (enlarged veins in the esophagus)
  • inflammation and ulcers
  • tumors (benign or malignant)
  • hiatal hernia - upward movement of the stomach, either into or alongside the esophagus
  • damage caused by ingestion of caustic substances (chemicals such as lye, household detergents)

    An EGD may be performed therapeutically to control bleeding, remove tumors or polyps (growths), dilate narrowed areas in the upper GI tract (e.g., esophagus), remove foreign objects, perform laser therapy, and place a percutaneous gastrostomy tube (a tube used for tube feeding into the stomach).
    Tissue samples (biopsies) or gastrointestinal fluid samples may be obtained via an endoscope. In addition, an EGD may be used to evaluate the stomach and duodenum after a surgery.
    There may be other reasons for your physician to recommend an esophagogastroduodenoscopy.

    Risks of the Procedure

    As with any invasive procedure, complications can occur. Some possible complications may include, but are not limited to, the following:
  • infection
  • bleeding
  • perforation (a tear in the lining) of the duodenum, esophagus, or stomach
Patients who are allergic to or sensitive to medications, contrast dyes, iodine, shellfish, or latex should notify their physician.
If you are pregnant or suspect that you are pregnant, you should notify your physician.
EGD is contraindicated in patients who have a large aortic aneurysm, Zenker's diverticulum (a herniated pouch in the esophagus), a recent perforated ulcer, or a perforation elsewhere in the GI tract.
There may be other risks depending upon your specific medical condition. Be sure to discuss any concerns with your physician prior to the procedure.
Barium within the intestines from a recent barium procedure may interfere with an EGD.

Before the Procedure

  • Your physician will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.
  • You will be asked to sign a consent form that gives your permission to do the test. Read the form carefully and ask questions if something is not clear.
  • Notify your physician if you are sensitive to or are allergic to any medications, latex, tape, and anesthetic agents (local and general).
  • You will be asked not to eat or drink liquids for eight hours before the procedure, generally after midnight. You may be given additional instructions about a special diet for one to two days prior to the procedure.
  • If you are pregnant or suspect that you are pregnant, you should notify your physician.
  • Notify your physician of all medications (prescribed and over-the-counter) and herbal supplements that you are taking.
  • Notify your physician if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, ibuprofen, naproxen, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure.
  • Your physician will instruct you about specific ways to prepare your bowel for the test. You may be asked to take a laxative, undergo an enema, use a rectal laxative suppository, and/or drink a special fluid that helps prepare your bowel.
  • Patients with diseases of the heart valves may be given antibiotics before the procedure.
  • You will be awake during the procedure, but a sedative will be given before the procedure. You will need someone to drive you home afterwards.
  • Based upon your medical condition, your physician may request other specific preparation.


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