Has your doctor told you that you need an upper endoscopy, also referred to as an esophagogastroduodenoscopy (EGD)? While not a routine procedure, the EGD is useful for the diagnosis and treatment of gastrointestinal illness, as well as for monitoring chronic problems. Whether this is your first endoscopy, or you have had one before, you may have a few questions about what to expect before, during, and after your procedure. An upper endoscopy is a procedure performed by a trained doctor to visualize your upper gastrointestinal (GI) tract by passing a flexible tube with a light and a camera through the mouth or nose. The areas observed include the tube that connects your mouth to your stomach, called the esophagus, the stomach and the first part of the small intestine, called the duodenum. Most, but not all, people are sedated during the procedure, and will remember little to nothing when they wake up; and very few people have any complications. So, if you are scheduled for an upper endoscopy procedure, here is an overview of what you can expect.
Why Would I Need an Endoscopy?
There are a number of reasons your doctor might recommend an endoscopy, and most fall into three categories – diagnosis of symptoms, monitoring known illnesses, or treatment of disease. Some of the signs or symptoms that would prompt a need for an EGD include unexplained, persistent pain of the upper abdomen, especially if you are over 50 years old; persistent nausea and vomiting; unexplained anemia; frank (or hidden) blood in your vomit or stool; difficulty swallowing; or abnormal X-rays.
If you have gastroesophageal reflux disease (GERD) and have not improved with medications, your doctor will probably also want to take a look at the tissue in your GI tract. If you have a known illness such as Barrett’s esophagus or a tumor, having an endoscopy will allow your doctor the opportunity to evaluate if treatment is helping or if the disease is stable. Also, sometimes an endoscopy is needed to perform a function such as removing a foreign object that is stuck in the esophagus, or to open an esophagus that is narrow and causing swallowing problems. Be sure to talk to your doctor beforehand, so that you understand exactly why you need an endoscopy, and what his or her expectations and goals for the procedure are.
Before the Endoscopy
There is generally no prep for you to take prior to an upper endoscopy, but your doctor will give you guidelines about what to eat or drink beforehand, and how you should take your usual medications. Generally, you will be asked to not eat or drink for 4 to 8 hours prior to the procedure. It is very important to follow this recommendation, because the procedure may need to be postponed if you don’t. You will usually be able to take your routine medications with some exceptions and changes; these should be discussed in advance with your doctor. For instance, if you take aspirin, NSAIDs (nonsteroidal anti-inflammatory drugs like ibuprofen), and certain vitamins or supplements, you may be asked to stop these for up to a week before the test.
If you take routine anticoagulants (like Coumadin or Plavix), you should discuss if and how you should take them prior to the procedure. Do not stop these medications before talking to your doctor first, and make sure your doctor knows that you are taking them. If you are a diabetic, you may need to adjust your medications or insulin, but should do this only on the recommendation of your doctor. You will most likely be able to take all the rest of your routine medications with a sip of water, but again, verify this with your doctor.
You should expect to receive written instructions from the doctor performing the endoscopy at least a week prior to the procedure. Be sure to read over all the information and ask questions if there is something you are not sure about. If you fail to follow all the recommendations, your procedure may be postponed or cancelled.
When You Arrive
You will be given a specific time to arrive prior to your procedure. This will allow time for any preparations that may need to be made before you have the endoscopy. You will be asked to change into a hospital gown and your medical history will be reviewed. Please make sure to bring a list of all of your medications and let the staff know what you have taken that day. At this time, the procedure will be explained to you, including what the doctor plans to do, what the risks and benefits are, what alternatives may exist, what the expected outcome is, and what limitations may exist to achieving the goals of the procedure.
Usually there is no need for laboratory tests prior to the exam, but depending on your circumstances, you may need a pregnancy test. Next, an intravenous line (IV) will be started so that you can receive fluids and medications through it. Now you will be ready for the procedure.
During the Endoscopy
Once in the procedure room, you will be asked to lie on your left side on the exam table. Next, a mouth guard will be placed in your mouth so that the endoscope will not damage your teeth. At this point, if you are receiving sedation, you will start to be sleepy and will most likely remain asleep throughout the procedure, which generally takes about 10 to 20 minutes. Because of the sedation medication, patients are generally unaware of what is going on and do not remember anything when they wake up.
Once you are sedated, the doctor will guide the flexible gastroscope, which is about the same thickness as a finger, through the esophagus, into the stomach, and then into the duodenum. There is a light and lens on the end of the tube that sends images back to a TV monitor, so the doctor can visualize the tissue of your GI tract. During this time, any additional procedures that are needed, such as removing a foreign object, taking a biopsy, or dilating a narrow portion of the esophagus, will be done. These procedures are not painful. The most discomfort you may experience during or after the procedure is usually bloating that results from air that is pushed into the GI tract to expand areas for better visualization or for passing of the tube. Once everything is completed, the tube will be removed and you will be allowed to wake up from the sedation.
Recovery and Discharge
After the endoscopy, you will be given time to fully wake up. Once alert enough, you will be given something light to eat and drink. You might still feel a little fuzzy and have difficulty concentrating. This is just residual effect from the sedation that will wear off. However, most doctors will require that you have someone drive you home, because the medications you have been given can decrease your reflexes until they are completely cleared from your system. You will also be asked to not return to work, not use heavy machinery, and not make any major decisions for the rest of the day.
You should not feel any pain after an endoscopy. The worst discomfort you might feel is bloating, and a mild sore throat. If you feel anything more severe than this, you should notify your doctor.
As an upper endoscopy is a relatively safe procedure, complications are uncommon. Aspiration of stomach content into the lungs can occur, but the risk is greatly reduced by abstaining from eating and drinking prior to the exam, as directed. It is also possible to have a reaction to the sedation medication. This is why it is important to let your doctor know if you have ever had a reaction to any medication. Occasionally, bleeding can occur from the site of a biopsy, but this should stop quickly on its own. If you notice persistent bleeding, you should call the doctor. Finally, while it is extremely rare, there is always the possibility that a hole could be torn in one of the structures being examined. However, overall, an upper endoscopy is a very safe procedure that can be a useful tool in the diagnosis and treatment of diseases of the upper GI tract.
At Austin Gastroenterology, your digestive health is our top priority. If you have any questions regarding upper endoscopies, or any concerning symptoms you would like to discuss, call us at an office near you to set up an appointment: North Office (512) 244-2273, Central Office (512) 454-4588, and South Office (512) 448-4588. If you are an existing patient, you can request an appointment online.