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EGD – Upper Endoscopy: Procedure, Uses and Risks

EGD (esophagogastroduodenoscopy) is an endoscopic procedure used to examine the esophagus, stomach, and duodenum. It is a key diagnostic and therapeutic tool for upper gastrointestinal conditions.

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Things worth knowing about "EGD"

EGD (esophagogastroduodenoscopy) is an endoscopic procedure used to examine the esophagus, stomach, and duodenum. It is a key diagnostic and therapeutic tool for upper gastrointestinal conditions.

What is an EGD?

Esophagogastroduodenoscopy, commonly abbreviated as EGD, is an endoscopic examination of the upper digestive tract. Using a thin, flexible tube equipped with a camera – called an endoscope – a physician can directly visualize the inner lining of the esophagus, stomach, and the first part of the small intestine, the duodenum. The procedure is also known as upper endoscopy or gastroscopy and is one of the most frequently performed procedures in gastroenterology.

Indications

An EGD is recommended for a wide range of symptoms and suspected conditions, including:

Persistent upper abdominal pain or discomfort
Heartburn and suspected gastroesophageal reflux disease (GERD)
Difficulty swallowing (dysphagia)
Nausea, vomiting, or unexplained weight loss
Suspected peptic ulcer disease (gastric or duodenal ulcers)
Detection or exclusion of Helicobacter pylori infection
Investigation of upper gastrointestinal bleeding (e.g., blood in vomit, black tarry stools)
Surveillance for Barrett esophagus or gastric cancer
Collection of tissue samples (biopsies)

How the Procedure Works

Preparation

Patients are typically required to fast for at least 6 hours before the procedure to ensure a clear view of the stomach lining. Medications should be discussed with the treating physician in advance. Sedation (e.g., with propofol or midazolam) is commonly offered to make the procedure comfortable and virtually painless. Alternatively, a local anesthetic throat spray may be used without sedation.

During the Procedure

The endoscope is gently introduced through the mouth and guided through the esophagus into the stomach and duodenum. A small camera at the tip transmits real-time images to a monitor, allowing the physician to:

Thoroughly assess the mucosal lining
Take tissue biopsies for laboratory analysis
Remove polyps
Treat active bleeding
Dilate narrowed areas (strictures or stenoses)

The examination typically takes 5 to 15 minutes; therapeutic interventions may require additional time.

After the Procedure

If sedation was used, patients should arrange for someone else to drive them home and are advised to rest for a few hours. Mild throat discomfort or a temporary sensation of pressure is normal. Results are usually discussed immediately after the procedure.

Risks and Side Effects

EGD is considered a very safe procedure. Rare but possible complications include:

Perforation of the esophagus or stomach – extremely rare
Minor bleeding following biopsy – usually self-limiting
Reactions to sedative medications
Temporary sore throat or hoarseness

Clinical Significance

EGD is regarded as the gold standard for diagnosing conditions of the upper gastrointestinal tract. It combines direct visual assessment of the mucosa with the ability to perform therapeutic interventions in the same session. Compared to imaging techniques such as ultrasound or X-ray, EGD provides superior mucosal detail and allows for simultaneous tissue sampling and treatment.

References

American Society for Gastrointestinal Endoscopy (ASGE): Guidelines for the use of upper gastrointestinal endoscopy. Gastrointestinal Endoscopy, 2022. Available at: https://www.asge.org
Kochman ML, Elta GH. Gastrointestinal Endoscopy. In: Kasper DL et al. (eds.): Harrison's Principles of Internal Medicine, 21st edition. McGraw-Hill, 2022.
Laine L et al.: Upper Gastrointestinal Bleeding Due to a Peptic Ulcer. New England Journal of Medicine, 2016;374:2367-2376.

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