Dr. Bader Faiyaz Zuberi
Consultant Gastroenterogist & Hepatologist, Assistant Professor
Dow University of Health Sciences, Karachi, Pakistan

Esophagogastroduodenoscopy (EGD) is an endoscopic procedure that allows direct examination of the esophagus, stomach, and duodenum. The examination takes approximately 30–60 minutes and may be performed as an outpatient in a procedure room, or in a hospital. Upper endoscopy is well tolerated with minimal discomfort (Figure 1 A,B).

EGD may be used to evaluate abdominal pain, heartburn, persistent nausea or vomiting, swallowing difficulties, upper gastrointestinal bleeding, chest pain in the absence of heart disease or bloody stools. It may also be used for periodic screening, surveillance, to remove foreign bodies or to control bleeding.

Prior to the procedure, the patient is registered and a medical history documented. Then, a needle/catheter is inserted into a vein for intravenous access (allowing for fluid and sedative administration). The throat may be treated with a topical anesthetic to suppress the gag reflex. Pain medication and a sedative may also be administered before the procedure. A plastic mouthpiece is placed between the teeth to prevent damage to the endoscope. As the patient swallows, the endoscope is guided through the esophagus, stomach, and duodenum while the physician examines the mucosa (lining) displayed on a monitor (Figure 2).

Air may be introduced through the endoscope distending the folds of tissue and enhancing the examination. A variety of accessory equipment may be used through the endoscope to obtain tissue biopsies or samples of digestive fluid, which are sent to the laboratory for analysis. At the completion of the examination, the endoscope is withdrawn.

On completion of the examination, the patient is taken to the recovery area. Patients are observed for 1–2 hours until the effects of the medication wear off. The physician will inform the patient about the results of the EGD and provide additional information as needed. Patients are discharged with instructions to have limited activity for the remainder of the day. Patients may experience belching and/or flatulence for the next 24 hours. In addition they may experience some throat discomfort.

Esophagogastroduodenoscopy is safe and effective when performed by professionals with appropriate training and experience. Complications are rare (1 out of 1,000), and may include bleeding, perforation, aspiration, or adverse reaction to the anesthetic or medication. Patients should contact their physician in the event of difficulty swallowing, pain, fever, bloody stools or blood in vomit following their procedure.