Examining the esophagus, the stomach and the duodenum
An esophagogastroduodenoscopy (EGD) is a procedure performed by the physician with the purpose of examining the esophagus, the stomach and the duodenum. It is also called an upper endoscopy or an upper gastrointestinal (UG) endoscopy. In this technique, the mucosal membrane of the food pipe, the stomach and the duodenum, which is the initial part of the small intestine, is viewed with the help of a small camera mounted on a flexible endoscope introduced into the body through the mouth.
Process of EGD
The entire process of EGD is explained to the patient and her consent is taken. She is advised to remain empty stomach for a minimum of six hours before the procedure. Any artificial dentures are removed. An intravenous line is started to administer medicines during the procedure. The patient is administered painkillers and a mild sedative to allay her apprehensions. A mouth guard is put in place to protect the patient from injuring her tongue or teeth during the procedure. A local anesthetic is sprayed on the back of the throat to avoid gag reflex and coughing during the procedure.
Once the patient is under the effect of the sedative, she is made to lie on her left side. The endoscope is introduced into the mouth and gradually pushed down the throat along with the swallowing of the patient. It is pushed down through the esophagus to the stomach and then further down up to the duodenum. Air and water are also introduced through the endoscope to ensure better visibility. During the procedure, the mucus membrane of the esophagus, the stomach and the duodenum are studied and necessary biopsies taken if required. As taking biopsy may lead to blood loss, so the patient is asked to stop aspirin or any other anti-clotting medication that she may be taking, at least 48 hours before the procedure. The entire process of EGD takes around 15-20 minutes.
Conditions warranting a need for an EGD
A patient may be asked to undergo an EGD if she complains of persistent heartburn or retrosternal pain; there is regurgitation of food; difficulty in gulping down the food, queasiness or vomiting, evidence of blood in vomiting, black stools, undue paleness of skin or unexplained weight loss. An EGD is also undertaken to corroborate the findings obtained by other investigating techniques like x-rays, ultrasonography and CT scans. It is preferred over other methods in case of suspicion of any ulcer or growth in the esophagus, stomach or the duodenum as the clinician can actually view the site of pathology.
Benefits of EGD
EGD is not only a diagnostic tool but it can also be used for therapeutic purposes.
- Apart from examination, brush biopsies can be taken from the suspicious sites. These are helpful in differentiating between a simple inflammation of the mucosa and an early stage malignancy.
- Differentiation between a benign and a malignant tumor can also be made based on the pathological examination of the punch biopsies taken while performing an EGD.
- Areas of stricture in the esophagus can be stretched.
- Small polyps and growths can be excised during the course of the procedure.
- Any bleeding vessel (as in esophageal varices present in liver cirrhosis) can be cauterized.
- Bleeding from the site of an ulcer can also be stopped.
- Foreign bodies like coins, buttons, etc which have been accidentally swallowed, especially in children, can be taken out.
- It is helpful in establishing the diagnosis of diseases like
a. gastro-esophageal reflux disease (GERD), wherein there is recurrent vomiting because of the extra acid production by the stomach
b. esophageal and gastric hernia
c. hiatus hernia, wherein a part of stomach protrudes into the thoracic cavity because of inherent weakness of the muscles of the diaphragm
d. achalasia cardia, a condition in which the lower esophageal valve fails to relax properly leading to incomplete emptying of esophageal contents into the stomach and resultant dilatation of lower end of esophagus
e. Peptic ulcers, characterized by the break in continuity of the mucosal membrane lining the stomach or the duodenum
f. Barrett’s esophagus, a condition where the cells of the lower part of esophagus undergo metaplastic changes which may ultimately lead to adenocarcinoma of esophagus, a fatal disease.
g. Mallory Weiss syndrome, a condition in which there is a tear in the mucosa at the junction of esophagus and stomach caused by excessive retching or violent vomiting.
h. Diseases of the small intestine like Crohn’s disease and irritable bowel syndrome (IBS).
Interpretation of the results of EGD
A normal EGD means that the esophagus, stomach and duodenum are free of any narrowing, growths, attritions or bleeding. An abnormal EGD may show the presence of any of the above mentioned conditions or the presence of any pouches, tears or infection.
Contra-indications for EGD
EGD is not supposed to be undertaken in patients who have esophageal diveticulae, any bleeding or clotting disorder, a suspected hole in the esophagus or stomach or those who have recently undergone any surgery related to mouth, thorax or upper gastro-intestinal tract.
Possible complications and side effects
The patient may very rarely have undesirable side effects of the anesthetic medication like dryness of mouth, shortness of breath, reduced pulse rate, a fall in blood pressure, flushing, tightness around the throat and a lot of sweating.
The side effects of EGD procedure include some soreness of throat which lasts for a day or two. It is because of some irritation caused by the endoscope. There may also be some distension of the abdomen owing to the gas which was introduced during the process for a better examination.
There may be some bleeding from the site of biopsy. Sometimes, the endoscope may damage the mucosal membrane of the esophagus, stomach or duodenum resulting in some bleeding. A very rare complication of EGD is that the endoscope itself may cause perforation of stomach or duodenum which may require surgery to be repaired. High grade pyrexia, any tenderness in upper abdomen, vomiting out of blood or tarry stools after the procedure should be reported to the physician immediately.