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 Digestion, digestive system that leads from the mouth to the anus. The tract is the largest of the body's systems, after the cardiovascula ...

down to the

duodenum The duodenum is the first section of the small intestine in most vertebrates, including mammals, reptiles, and birds. In mammals, it may be the principal site for iron absorption. The duodenum precedes the jejunum and ileum and is the shortest p ...

. It is considered a minimally invasive procedure since it does not require an incision into one of the major body cavities and does not require any significant recovery after the procedure (unless sedation or

anesthesia Anesthesia (American English) or anaesthesia (British English) 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 prev ...

has been used). However, a

sore throat Sore throat, also known as throat pain, is pain or irritation of the throat. The majority of sore throats are caused by a virus, for which antibiotics are not helpful. For sore throat caused by bacteria (GAS), treatment with antibiotics may hel ...

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 lang ...

) and ''oesophagogastroduodenoscopy'' (OGD;

British English British English is the set of Variety (linguistics), varieties of the English language native to the United Kingdom, especially Great Britain. More narrowly, it can refer specifically to the English language in England, or, more broadly, to ...

; see

spelling differences Despite the various English dialects spoken from country to country and within different regions of the same country, there are only slight regional variations in English orthography, the two most notable variations being British and Americ ...

) are 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 Anemia (also spelt anaemia in British English) is a blood disorder in which the blood has a reduced ability to carry oxygen. This can be due to a lower than normal number of red blood cells, a reduction in the amount of hemoglobin availabl ...

(usually along with a

colonoscopy Colonoscopy () or coloscopy () is a medical procedure involving the Endoscopy, endoscopic examination of the large bowel (colon) and the distal portion of the small bowel. This examination is performed using either a Charge-coupled device, CCD ...

) * Upper gastrointestinal bleeding as evidenced by hematemesis or melena * 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 – vomiting *

Dysphagia Dysphagia is difficulty in swallowing. Although classified under " symptoms and signs" in ICD-10, in some contexts it is classified as a condition in its own right. It may be a sensation that suggests difficulty in the passage of solids or l ...

– difficulty in swallowing * Odynophagia – painful swallowing * Persistent

nausea Nausea is a diffuse sensation of unease and discomfort, sometimes perceived as an urge to vomit. It can be a debilitating symptom if prolonged and has been described as placing discomfort on the chest, abdomen, or back of the throat. Over 30 d ...

* IBD (

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

Surveillance

* Surveillance of Barrett's esophagus * Surveillance of gastric ulcer or duodenal ulcer * Occasionally after gastric surgery

Confirmation of diagnosis/biopsy

* Abnormal barium swallow or barium meal * Confirmation of

celiac disease Coeliac disease (British English) or celiac disease (American English) is a long-term autoimmune disorder, primarily affecting the small intestine. Patients develop intolerance to gluten, which is present in foods such as wheat, rye, spel ...

(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 a ...

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 with a

balloon A balloon is a flexible membrane bag that can be inflated with a gas, such as helium, hydrogen, nitrous oxide, oxygen, or air. For special purposes, balloons can be filled with smoke, liquid water, granular media (e.g. sand, flour or rice), ...

* Application of photodynamic therapy for treatment of esophageal malignancies * Endoscopic drainage of pancreatic pseudocyst * Tightening the lower esophageal sphincter * Dilating or stenting of

stenosis Stenosis () is the abnormal narrowing of 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'' as a term is usually used when narrowing ...

achalasia Esophageal achalasia, often referred to simply as achalasia, is a failure of smooth muscle fibers to relax, which can cause the lower esophageal sphincter to remain closed. Without a modifier, "achalasia" usually refers to achalasia of the esopha ...

Percutaneous endoscopic gastrostomy Percutaneous endoscopic gastrostomy (PEG) is an endoscopic medical procedure in which a tube (PEG tube) is passed into a patient's stomach through the abdominal wall, most commonly to provide a means of feeding when oral intake is not adequate ...

(feeding tube placement) * Endoscopic retrograde cholangiopancreatography (ERCP) combines EGD with

fluoroscopy Fluoroscopy (), informally referred to as "fluoro", is an imaging technique that uses X-rays to obtain real-time moving images of the interior of an object. In its primary application of medical imaging, a fluoroscope () allows a surgeon to see t ...

* Endoscopic ultrasound (EUS) combines EGD with 5–12 MHz

ultrasound Ultrasound is sound with frequency, frequencies greater than 20 Hertz, kilohertz. This frequency is the approximate upper audible hearing range, limit of human hearing in healthy young adults. The physical principles of acoustic waves apply ...

imaging

Newer interventions

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

bariatric surgery Bariatric surgery (also known as metabolic surgery or weight loss surgery) is a surgical procedure used to manage obesity and obesity-related conditions. Long term weight loss with bariatric surgery may be achieved through alteration of gut ho ...

Complications

The complication rate is about 1 in 1000. They include: * aspiration, causing

aspiration pneumonia Aspiration pneumonia is a type of lung infection that is due to a relatively large amount of material from the stomach or mouth entering the lungs. Signs and symptoms often include fever and cough of relatively rapid onset. Complications may incl ...

* bleeding * perforation * cardiopulmonary problems When used in

infant In common terminology, a baby is the very young offspring of adult human beings, while infant (from the Latin word ''infans'', meaning 'baby' or 'child') is a formal or specialised synonym. The terms may also be used to refer to juveniles of ...

s, the esophagogastroduodenoscope may compress the trachealis muscle, which narrows the

trachea The trachea (: tracheae or tracheas), also known as the windpipe, is a cartilaginous tube that connects the larynx to the bronchi of the lungs, allowing the passage of air, and so is present in almost all animals' lungs. The trachea extends from ...

. This can result in reduced airflow to the

lung The lungs are the primary Organ (biology), organs of the respiratory system in many animals, including humans. In mammals and most other tetrapods, two lungs are located near the Vertebral column, backbone on either side of the heart. Their ...

s. Infants may be

intubated Intubation (sometimes entubation) is a medical procedure involving the insertion of a tube into the body. Most commonly, intubation refers to tracheal intubation, a procedure during which an endotracheal tube is inserted into the trachea to supp ...

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 Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder characterized by a group of symptoms that commonly include abdominal pain, abdominal bloating, and changes in the consistency of bowel movements. These symptoms may ...

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 of the

oropharynx The pharynx (: pharynges) is the part of the throat behind the mouth and nasal cavity, and above the esophagus and trachea (the tubes going down to the stomach and the lungs respectively). It is found in vertebrates and invertebrates, though its ...

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

Informed consent Informed consent is an applied ethics principle that a person must have sufficient information and understanding before making decisions about accepting risk. Pertinent information may include risks and benefits of treatments, alternative 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 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, or more generically referred to as an ''image'' or ''picture'') is an image created by light falling on a photosensitivity, photosensitive surface, usually photographic film or an electronic image sensor. Th ...

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 A biopsy is a medical test commonly performed by a surgeon, interventional radiologist, an interventional radiologist, or an interventional cardiology, interventional cardiologist. The process involves the extraction of sampling (medicine), sample ...

is a valuable adjunct to endoscopy. Small biopsies can be made with a pincer (biopsy

forceps Forceps (: forceps or considered a plural noun without a singular, often a pair of forceps; the Latin plural ''forcipes'' is no longer recorded in most dictionaries) are a handheld, hinged instrument used for grasping and holding objects. Forcep ...

) 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. Clinical practice varies with respect to routine biopsy for histological analysis of the examined upper gastrointestinal system. A rapid urease test is quick, easy, and cost-effective screening for Helicobacter pylori infection.

Equipment

Endoscope An endoscope is an inspection instrument composed of image sensor, optical lens, light source and mechanical device, which is used to look deep into the body by way of openings such as the mouth or anus. A typical endoscope applies several modern ...

** 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 formed by the combination of acetic acid with a base (e.g. alkaline, earthy, metallic, nonmetallic, or radical base). "Acetate" also describes the conjugate base or ion (specifically, the negatively charged ion called ...

** Indigo carmine

Gallery

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 gastric ulcer Image:celiac 3.jpg, Endoscopic still of

of patient with

showing scalloping of folds. Image:MALT 4.jpg, Gastric ulcer in antrum of

stomach The stomach is a muscular, hollow organ in the upper gastrointestinal tract of Human, humans and many other animals, including several invertebrates. The Ancient Greek name for the stomach is ''gaster'' which is used as ''gastric'' in medical t ...

with overlying clot due to gastric lymphoma. Image:DU 2.jpg , Endoscopic image of a posterior wall duodenal ulcer with a clean base, which is a common cause of upper GI hemorrhage. 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