Q: Last week when we talked about GERD and acid reflux you mentioned a procedure called an EGD and that we would talk about it more this week…so can you tell me what that is?

A: An EGD is the abbreviation for a word I struggle to say and probably why everyone calls it an EGD or an upper endoscopy…but it stands for esophago-gastro-duodenoscopy…right? Hard. Anyway, this procedure is how a physician can look at your esophagus, stomach, and duodenum which is the first part of your small intestines that connects to your stomach. This allows us to see ulcers, irritation, tumors, bleeding and so on in any of those areas by using a small camera on the end of a flexible tube. It sounds a lot scarier than it actually is. 

Q: Yeah…can you explain what actually happens and what to expect?

A: Normally this is an outpatient procedure. That means you come in that day of and leave maybe an hour or less after it’s done, assuming there are no complications. We will discuss those in a bit, but major complications are not very common. Anyway, you will come in and be seen by a nurse and have to put on a gown and get your heart rate and blood pressure taken and then you will have a nurse, the physician/endoscopist doing the procedure, and possibly an anesthesia provider asking you the same questions…medical problems, reason for the procedure, allergies, when was the last time you ate, etc. You are given instructions prior to coming in for the procedure where they will tell you not to eat or drink anything for anywhere from 8-24 hours beforehand. They may ask you to stop taking certain medications like blood thinners or aspirin but that will all be personalized to your situation. After you talk to all the people and you’re ready to go you will taken into a small procedure room where the EGD will take place. Some physicians prefer to do these with the assistance of an anesthesiologist and some prefer to do their own sedation…either way…you won’t remember it and the next thing you know you’ll be in recovery. Everyone will stop what they are doing and say your name and what procedure is being done so that everyone knows they are doing the correct procedure on the correct person. After that you will be given medication that will make you tired and kind of just makes you forget what’s going on. You might not be fully asleep, but you won’t remember anything. I have heard some physicians do not use medication for sedation and they only numb the back of your throat, but I have never seen that done so I don’t know how common that is. Once the medication is given this little plastic block with a hole in the center is put in in your mouth. This bite block keeps you from biting down on and ruining a very expensive scope with your teeth. The scope is usually about the size of an adult finger in width. There is a light and high end cameras on the end of the tubing. Once you are asleep the camera is put through the bite block and down your esophagus…a lot of times we have to ask people to swallow it because they are awake enough to do that, but they don’t ever remember it afterwards. With the camera in your esophagus we can look for all those things I mentioned earlier, like ulcers and such, but we can also take pictures and biopsies of anything that looks concerning or suspicious…or even normal…but we sort of do this backwards and look at the esophagus on the way out. On the way down we just want to get into the stomach. We look all around for all the same things, take pictures, take biopsies and then we go through the pylorus which is the muscle that separates the stomach from the small intestine and helps regulate how much food gets released from the stomach once its been digested. In the small intestine we look for the opening where the common bile duct from your liver and pancreatic duct from your pancreas drain into the small intestine and we also look for tumors or any signs of disease. We then pull the camera back into the stomach…and then into the esophagus and take a good look around on the way out. Once the camera is out, the bite block is removed, you’re taken to recovery and sent home usually in about an hour. You’ll be given instructions and someone will have to drive you home…so they are also given those same instructions because you probably won’t remember them. Then if biopsies were taken they will see you back in the office in about 2 weeks and talk about the pathology and go from there. 

Q: …whatever you want to say about all that crazy crap I just mentioned hahaha…what are the complications you mentioned earlier? 

A: Some of the complications can be an adverse reaction to the medication, an allergic reaction to the medication, redness or pain around your IV site. That’s why you have so many people asking you about allergies and things beforehand. You can have some bleeding from biopsy sites. It is not common for the bleeding to be severe and it will usually subside on its own. Aspiration is a more serious concern…that happens when you inhale into your lungs the contents from your stomach. It can result in a pneumonia and other lung complications and why it is so important to not eat or drink before your EGD and be honest about the timing of your last meal. The most serious complication and that the scope can put a hole in your esophagus, stomach, or small intestines either from pressure from the scope or from a biopsy that was maybe a little too deep. This is known as a perforation. If a perforation is noted at the time of the EGD…depending on where it is…it can be clipped closed and you would be monitored in the hospital overnight. A lot of times it isn’t noticed at the time of the EGD…and it can be in any of those 3 locations. A perforation can result in serious complications and even death it you don’t call your doctor or come to the ER immediately when you are having concerning symptoms. A perforation usually results in an operation. That operation can be in the neck, chest, or abdomen depending on where the perforation is and may mean you will be in the hospital for several days and may need further operations. A perforation is a very serious, but rare complication of this procedure. Symptoms that should prompt you to seek immediate medical attention would be things like severe abdominal pain that is worse than just gas pain, a firm and distended abdomen, severe abdominal pain with movement, vomiting, a fever, difficulty swallowing or severe throat pain, a crunching feeling under the skin of the neck, and passage of bright red or black material in your vomit or stools. 

I know this sounds super scary and like the worst things can happen, but I promise it’s not that bad. I had one done a few years ago and I didn’t have a bad experience at all. I don’t remember anything after getting into the room and then I woke up in the recovery room. I will tell you…do not drink coffee or eat spicy food or anything like that afterwards…especially if they took biopsies…it does not feel good. 

As with everything…talk to your doctor about your concerns and ask questions before hand. Don’t be afraid to ask questions about the procedure, what to expect, what you need to do, etc. The more you know the more you will feel comfortable with what’s going on and it’s our job to explain things so ask away. Just remember, everyone is different so what works for your friend or your neighbor may not be what works for you and it is so important to discuss your specific complaints with your doctor to make sure you get what is best for you!

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