What is an EGD?Stomach
An EGD (upper endoscopy, gastroscopy, panendoscopy) is an examination of the esophagus (food pipe), stomach and duodenum (first part of the small intestine) via insertion of an endoscope (small diameter, flexible tube) through the mouth and back of the throat into the upper digestive tract.  This allows the physician to examine the lining of the above organs.  Abnormalities suspected by x-ray can be confirmed and others may be detected which are too small to be seen on x-ray.  If the doctor sees a suspicious area, he can pass an instrument through the endoscope and take a small piece of tissue (a biopsy) for more thorough examination in the laboratory.  Biopsies are taken for many reasons and do not necessarily imply cancer.  Other instruments can also be passed through the endoscope without causing discomfort, including a small brush to wipe cells in a suspicious area for examination in the laboratory (a form of Pap test or "cytology") and a wire loop or snare to remove polyps (abnormal, usually benign, growths of tissue). 

Do I really need an EGD?
Many problems of the upper digestive tract cannot be diagnosed by x-ray.  EGD may be helpful in the diagnosis of inflammation of the esophagus, stomach and duodenum (esophagitis, gastritis, duodenitis), and to identify the site of upper gastrointestinal bleeding.  EGD is more accurate than x-ray in detecting stomach and duodenal ulcers, especially when there is bleeding or scarring from a previous ulcer.  EGD may detect early cancers too small to be seen by x-ray and confirm the diagnosis through biopsies and cell brushings.  EGD may also be needed for treatments, for example, to stretch narrowed areas of the esophagus, control of upper gastrointestinal bleeding, or for the removal of polyps. 

What preparation is required?
For the best possible examination, the stomach must be completely empty, so you should have nothing to eat or drink, including water, from midnight the evening before your exam.  A companion must accompany you to the examination because you will be given medication to help you relax.  It will make you drowsy, so you will need someone to drive you home. You will not be able to drive after the procedure.  Even though you may not feel tired, your judgment and reflexes may not be normal.  Please bring any x-rays with you, if requested.  Plan on arriving at the hospital one hour before your test is scheduled.

What should I expect during the procedure?
Your doctor will give you medication through a vein to make you relaxed and sleepy.  Please inform the doctor if you have any allergies to drugs before your test.  While you are lying on your left side, the endoscope is inserted through the mouth and each part of the esophagus, stomach and duodenum is examined.  The procedure is extremely well tolerated with little or no discomfort.  Many patients even fall asleep during EGD.  The scope will not interfere with your breathing.  Gagging is usually prevented by the medication.  The procedure usually lasts five to fifteen minutes. 

What happens after the test?
You will be kept in the endoscopy area until most of the effects of the medication have worn off.  Your throat may be a little sore for a couple of hours and you may feel bloated for a short time because of the air that was introduced to examine your stomach.  You will be able to resume your normal diet after the EGD unless otherwise instructed.  You will be given appropriate discharge instructions and learning material before you go home.  You should make arrangements in advance to have someone stay at your home with you for the day.

Are there any complications from EGD?
EGD is safe and is associated with very low risk when performed by physicians who have been specially trained in endoscopy procedures.  Complications can occur but are rare.  One possible complication is perforation, in which a tear through the wall of the esophagus or stomach may allow leakage of digestive fluids.  This may be managed simply by aspirating the fluids until the opening seals, or may require surgery.  Bleeding may occur from the site of biopsy or polyp removal.  It is usually minimal but rarely may require transfusions or surgery.  Localized irritation of the vein may occur at the site of medication injection.  A tender lump develops which may remain several weeks to months but goes away eventually.  Other risks include drug reactions and complications from unrelated diseases such as heart attack or stroke.

When will I know what my test showed?
Dr. Hasan will talk to you or the person accompanying your before you leave the endoscopy department and  preliminary results can usually be given to you at that time.  If a biopsy or cell brushing was taken, the results will not be received from the laboratory for 3 to 4 days. 


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