Esophagogastroduodenoscopy (EGD) or oesophagogastroduodenoscopy (OGD), also called by various other names, is a diagnostic endoscopic procedure that visualizes the upper part of the

gastrointestinal tract The gastrointestinal tract (GI tract, digestive tract, alimentary canal) is the tract or passageway of the digestive system that leads from the mouth to the anus. The GI tract contains all the major organ (biology), organs of the digestive syste ...

down to the

duodenum The duodenum is the first section of the small intestine in most higher vertebrates, including mammals, reptiles, and birds. In fish, the divisions of the small intestine are not as clear, and the terms anterior intestine or proximal intestine m ...

. It is considered a minimally invasive procedure since it does not require an

incision Incision may refer to: * Cutting, the separation of an object, into two or more portions, through the application of an acutely directed force * A type of open wound caused by a clean, sharp-edged object such as a knife, razor, or glass splinter ...

into one of the major body cavities and does not require any significant recovery after the procedure (unless

sedation Sedation is the reduction of irritability or agitation by administration of sedative drugs, generally to facilitate a medical procedure or diagnostic procedure. Examples of drugs which can be used for sedation include isoflurane, diethyl ether, ...

anesthesia Anesthesia is a state of controlled, temporary loss of sensation or awareness that is induced for medical or veterinary purposes. It may include some or all of analgesia (relief from or prevention of pain), paralysis (muscle relaxation), ...

has been used). However, a sore throat is common.

Alternative names

The words ''esophagogastroduodenoscopy'' (EGD;

American English American English, sometimes called United States English or U.S. English, is the set of variety (linguistics), varieties of the English language native to the United States. English is the Languages of the United States, most widely spoken lan ...

) and ''oesophagogastroduodenoscopy'' (OGD; British English; see spelling differences) are both pronounced . It is also called ''panendoscopy'' (PES) and ''upper GI endoscopy''. It is also often called just ''upper endoscopy'', ''upper GI'', or even just ''endoscopy''; because EGD is the most commonly performed type of endoscopy, the ambiguous term ''endoscopy'' is sometimes informally used to refer to EGD by default. The term ''gastroscopy'' literally focuses on the stomach alone, but in practice, the usage overlaps.

Medical uses

Diagnostic

* Unexplained anemia (usually along with a

colonoscopy Colonoscopy () or coloscopy () is the endoscopic examination of the large bowel and the distal part of the small bowel with a CCD camera or a fiber optic camera on a flexible tube passed through the anus. It can provide a visual diagnosis (''e. ...

) * Upper gastrointestinal bleeding as evidenced by hematemesis or

melena Melena or melaena refers to the dark black, tarry feces that are associated with upper gastrointestinal bleeding. The black color and characteristic strong odor are caused by hemoglobin in the blood being altered by digestive enzymes and intest ...

* Persistent dyspepsia in patients over the age of 45 years * Heartburn and chronic acid reflux – this can lead to a precancerous lesion called Barrett's esophagus * Persistent emesis * Dysphagia – difficulty in swallowing * Odynophagia – painful swallowing * Persistent nausea * IBD (

inflammatory bowel disease Inflammatory bowel disease (IBD) is a group of inflammation, inflammatory conditions of the colon (anatomy), colon and small intestine, Crohn's disease and ulcerative colitis being the principal types. Crohn's disease affects the small intestine a ...

Surveillance

* Surveillance of Barrett's esophagus * Surveillance of

gastric ulcer Peptic ulcer disease (PUD) is a break in the inner lining of the stomach, the first part of the small intestine, or sometimes the lower esophagus. An ulcer in the stomach is called a gastric ulcer, while one in the first part of the intestines i ...

duodenal ulcer Peptic ulcer disease (PUD) is a break in the inner lining of the stomach, the first part of the small intestine, or sometimes the lower esophagus. An ulcer in the stomach is called a gastric ulcer, while one in the first part of the intestines ...

* Occasionally after gastric surgery

Confirmation of diagnosis/biopsy

* Abnormal

barium swallow An upper gastrointestinal series, also called a barium swallow, barium study, or barium meal, is a series of radiographs used to examine the gastrointestinal tract for abnormalities. A contrast medium, usually a radiocontrast agent such as barium ...

or barium meal * Confirmation of celiac disease (via biopsy)

Therapeutic

* Treatment (banding/sclerotherapy) of esophageal varices * Injection therapy (e.g.,

epinephrine Adrenaline, also known as epinephrine, is a hormone and medication which is involved in regulating visceral functions (e.g., respiration). It appears as a white microcrystalline granule. Adrenaline is normally produced by the adrenal glands and ...

in bleeding lesions) * Cutting off of larger pieces of tissue with a snare device (e.g., polyps, endoscopic mucosal resection) * Application of cautery to tissues * Removal of foreign bodies (e.g., food) that have been ingested * Tamponade of bleeding

esophageal varices Esophageal varices are extremely dilated sub-mucosal veins in the lower third of the esophagus. They are most often a consequence of portal hypertension, commonly due to cirrhosis. People with esophageal varices have a strong tendency to develop ...

with a balloon * Application of photodynamic therapy for treatment of esophageal malignancies * Endoscopic drainage of

pancreatic pseudocyst A pancreatic pseudocyst is a circumscribed collection of fluid rich in pancreatic enzymes, blood, and non-necrotic tissue, typically located in the lesser sac of the abdomen. Pancreatic pseudocysts are usually complications of pancreatitis, altho ...

* Tightening the lower esophageal sphincter * Dilating or stenting of

stenosis A stenosis (from Ancient Greek στενός, "narrow") is an abnormal narrowing in a blood vessel or other tubular organ or structure such as foramina and canals. It is also sometimes called a stricture (as in urethral stricture). ''Stricture'' ...

or achalasia * Percutaneous endoscopic gastrostomy (feeding tube placement) * Endoscopic retrograde cholangiopancreatography (ERCP) combines EGD with fluoroscopy * Endoscopic ultrasound (EUS) combines EGD with 5–12 MHz ultrasound imaging

Newer interventions

* Endoscopic trans-gastric laparoscopy * Placement of gastric balloons in

bariatric surgery Bariatric surgery (or weight loss surgery) includes a variety of procedures performed on people who are obese. Long term weight loss through the standard of care procedures ( Roux en-Y bypass, sleeve gastrectomy, and biliopancreatic diversion ...

Complications

The complication rate is about 1 in 1000. They include: * aspiration, causing aspiration pneumonia * bleeding * perforation * cardiopulmonary problems When used in

infant An infant or baby is the very young offspring of human beings. ''Infant'' (from the Latin word ''infans'', meaning 'unable to speak' or 'speechless') is a formal or specialised synonym for the common term ''baby''. The terms may also be used to ...

s, the esophagogastroduodenoscope may compress the trachealis muscle, which narrows the trachea. This can result in reduced airflow to the

lung The lungs are the primary organs of the respiratory system in humans and most other animals, including some snails and a small number of fish. In mammals and most other vertebrates, two lungs are located near the backbone on either side of t ...

s. Infants may be

intubated Intubation (sometimes entubation) is a medical procedure involving the insertion of a tube into the body. Patients are generally anesthetized beforehand. Examples include tracheal intubation, and the balloon tamponade with a Sengstaken-Blakemo ...

to make sure that the trachea is fixed open.

Limitations

Problems of gastrointestinal ''function'' are usually not well diagnosed by endoscopy since ''motion'' or ''secretion'' of the gastrointestinal tract is not easily inspected by EGD. Nonetheless, findings such as excess fluid or poor motion of the gut during endoscopy can be suggestive of disorders of function. Irritable bowel syndrome and functional dyspepsia are not diagnosed with EGD, but EGD may be helpful in excluding other diseases that mimic these common disorders.

Procedure

The tip of the endoscope should be lubricated and checked for critical functions including tip angulations, air and water suction, and image quality. The patient is kept NPO (nil per os) or NBM (nothing by mouth) for at least 4 hours before the procedure. Most patients tolerate the procedure with only

topical anesthesia A topical anesthetic is a local anesthetic that is used to numb the surface of a body part. They can be used to numb any area of the skin as well as the front of the eyeball, the inside of the nose, ear or throat, the anus and the genital area. Topi ...

of the oropharynx using

lidocaine Lidocaine, also known as lignocaine and sold under the brand name Xylocaine among others, is a local anesthetic of the amino amide type. It is also used to treat ventricular tachycardia. When used for local anaesthesia or in nerve blocks, lidoca ...

spray. However, some patients may need sedation and the very anxious/agitated patient may even need a general anesthetic.

Informed consent Informed consent is a principle in medical ethics and medical law, that a patient must have sufficient information and understanding before making decisions about their medical care. Pertinent information may include risks and benefits of treatme ...

is obtained before the procedure. The main risks are bleeding and perforation. The risk is increased when a biopsy or other intervention is performed. The patient lies on their left side with the head resting comfortably on a pillow. A mouth-guard is placed between the teeth to prevent the patient from biting on the endoscope. The endoscope is then passed over the tongue and into the oropharynx. This is the most uncomfortable stage for the patient. Quick and gentle manipulation under vision guides the endoscope into the esophagus. The endoscope is gradually advanced down the esophagus making note of any pathology. Excessive insufflation of the stomach is avoided at this stage. The endoscope is quickly passed through the stomach and through the pylorus to examine the first and second parts of the

. Once this has been completed, the endoscope is withdrawn into the stomach and a more thorough examination is performed including a J-maneuver. This involves retroflexing the tip of the scope so it resembles a 'J' shape in order to examine the

fundus ''Fundus'' (Latin for "bottom") is an anatomical term referring to that part of a concavity in any organ, which is at the far end from its opening. It may refer to: Anatomy * Fundus (brain), the deepest part of any sulcus of the cerebral cortex * ...

and gastroesophageal junction. Any additional procedures are performed at this stage. The air in the stomach is aspirated before removing the endoscope. Still

photograph A photograph (also known as a photo, image, or picture) is an image created by light falling on a photosensitive surface, usually photographic film or an electronic image sensor, such as a CCD or a CMOS chip. Most photographs are now create ...

s can be made during the procedure and later shown to the patient to help explain any findings. In its most basic use, the endoscope is used to inspect the internal anatomy of the digestive tract. Often inspection alone is sufficient, but biopsy is a valuable adjunct to endoscopy. Small biopsies can be made with a pincer (biopsy forceps) which is passed through the scope and allows sampling of 1 to 3 mm pieces of tissue under direct vision. The intestinal mucosa heals quickly from such biopsies.

Equipment

* Endoscope ** Non-coaxial optic fiber system to carry light to the tip of the endoscope ** A chip camera at the tip of the endoscope – this has now replaced the coaxial optic fibers of older scopes that were prone to damage and consequent loss of picture quality ** Air/water channel to clean the lens using the water and air channel for drying the lens itself and to insufflate the esophagus and the stomach during the operation to prevent from collapsing the track to better vision in the procedure ** Suction/Working channels – these may be in the form of one or more channels ** Control handle – this houses the controls ** Umbilical Cords that connect to the light source and video processor to supply the endoscope with suction and air pressure and water for (suction and irrigation process) and light to transmit in the body to deliver the video signal to the processor to show the live image on the monitor * Stack ** Light source ** Suction ** Electrosurgical unit ** Video recorder/photo printer * Instruments ** Biopsy forceps ** Snares ** Injecting needles * Chemical agents ** Dimethicone **

Acetate An acetate is a salt (chemistry), salt formed by the combination of acetic acid with a base (e.g. Alkali metal, alkaline, Alkaline earth metal, earthy, Transition metal, metallic, nonmetallic or radical Radical (chemistry), base). "Acetate" als ...

** Indigo carmine Image:Duodenal adenocarcinoma.png, Endoscopic image of adenocarcinoma of duodenum seen in the post-bulbar duodenum. Image:Gastric_antral_vascular_ectasia_(before_and_after).png, Endoscopic image of gastric antral vascular ectasia seen as a radial pattern around the pylorus before (top) and after (bottom) treatment with argon plasma coagulation Image:Barretts esophagus.jpg, Endoscopic image of Barrett's esophagus, which is the area of red mucosa projecting like a tongue. Image:Deep gastric ulcer.png , Deep

Image:celiac 3.jpg, Endoscopic still of

of patient with celiac disease showing scalloping of folds. Image:MALT 4.jpg,

Gastric ulcer Peptic ulcer disease (PUD) is a break in the inner lining of the stomach, the first part of the small intestine, or sometimes the lower esophagus. An ulcer in the stomach is called a gastric ulcer, while one in the first part of the intestines i ...

in antrum of stomach with overlying clot due to

gastric lymphoma Primary gastric lymphoma (lymphoma that originates in the stomach itself) is an uncommon condition, accounting for less than 15% of gastric malignancies and about 2% of all lymphomas. However, the stomach is a very common extranodal site for lymp ...

. Image:DU 2.jpg , Endoscopic image of a posterior wall

with a clean base, which is a common cause of

upper GI hemorrhage Upper gastrointestinal bleeding is gastrointestinal bleeding in the upper gastrointestinal tract, commonly defined as bleeding arising from the esophagus, stomach, or duodenum. Blood may be observed in vomit or in altered form as black stool. De ...

. Early stomach cancer 2a.jpg, Endoscopic images of an early stage stomach cancer. 0-IIa, tub1. Left column: Normal light. Right column: computed image enhanced ( FICE). First row: Normal. Second row:

stained. Third row: Acetate-indigocarmine mixture ( AIM) stained.

References

{{Authority control Endoscopy Diagnostic gastroenterology