Norm of Esophagogastroduodenoscopy (EGD)
Normal upper gastrointestinal tract (that is, esophageal mucosa is smooth and pink, with visible submucosal blood vessels; stomach mucosa is composed of continuous, deeper red rugal folds; duodenal lining is covered with villi). All surfaces are free of ulcers, varices, bleeding, and lesions.
Usage of Esophagogastroduodenoscopy (EGD)
Biopsy, cancer, dysphagia, esophagitis, gastric ulcers, hiatal hernia, Mallory-Weiss tear, odynophagia (painful swallowing), postoperative examination of the gastrointestinal (GI) tract, and upper GI bleeding.
Description of Esophagogastroduodenoscopy (EGD)
Visualization of the esophagus, stomach, and upper duodenum with a fiberoptic scope that has a lighted mirror lens on the end. EGD is less sensitive than endoscopic ultrasound for detection of varices of the esophagus and stomach. See Endoscopic ultrasound.
Professional Considerations of Esophagogastroduodenoscopy (EGD)
Consent form IS required.
Gastrointestinal perforation and hemorrhage, aspiration, infection, respiratory arrest, death.
Zenker's diverticulum or large aortic aneurysm. Sedatives are contraindicated in clients with central nervous system depression.
During pregnancy, risks of cumulative radiation exposure to the fetus from this and other previous or future imaging studies must be weighed against the benefits of the procedure. Although formal limits for client exposure are relative to this risk: benefit comparison, the United States Nuclear Regulatory Commission requires that the cumulative dose equivalent to an embryo/fetus from occupational exposure not exceed 0.5 rem (5 mSv). Radiation dosage to the fetus is proportional to the distance of the anatomy studied from the abdomen and decreases as pregnancy progresses. For pregnant clients, consult the radiologist/radiology department to obtain estimated fetal radiation exposure from this procedure.
- Verify that the client has fasted.
- The client should urinate and attempt to defecate before the procedure to increase comfort.
- The client should remove dentures, partial plates, and jewelry.
- Assess for allergies to anesthetics.
- Establish intravenous access.
- Obtain specimen containers (one with 95% ethyl alcohol and the other with 10% formaldehyde), an endoscope, and an intravenous sedative.
- Measure and record heart rate, blood pressure, and respiratory rate.
- Attach electrodes for continuous ECG monitoring and initiate continuous-pulse oximetry measurement.
- Atropine may be prescribed to dry secretions before the test.
- Infusion of erythromycin before EGD reduces the need for second-look endoscopy in clients with upper GI bleeding.
- Just before beginning the procedure, take a “time out” to verify the correct client, procedure, and site.
- A topical, bitter-tasting anesthetic is applied to the throat and a mouth guard inserted if the client has teeth.
- Intravenous sedation is given.
- The endoscope is inserted into the esophagus and slowly advanced to the duodenum.
- Air is instilled to distend any area to aid in visualization.
- Biopsy specimens or photos may be taken.
- If deep sedation was used for the procedure, follow institutional protocol for post sedation monitoring. Typical monitoring includes continuous ECG monitoring and pulse oximetry, with continual assessments (every 5–15 minutes) of airway, vital signs, and neurologic status until the client is lying quietly awake, is breathing independently, and responds appropriately to commands spoken in a normal tone.
- Resume previous diet after the gag reflex returns and sedation has worn off, usually 2 hours after the procedure.
- Observe for signs of perforation: pain, fever, dyspnea, tachycardia, cyanosis, and pleural effusion.
Client and Family Teaching
- Ambulatory clients should arrange for transportation home because they will not be allowed to drive for 12 hours after the procedure.
- Fast from food and fluids for 8 hours before the test.
- You may receive medication to dry secretions during the test, and this will cause a dry mouth. Sedation may also be used to cause a relaxed state, which may or may not result in sleeping through the test. After a local anesthetic is sprayed into the back of the throat, you will be positioned lying on the side, and the flexible scope will be inserted through the mouth. Suction will remove any draining saliva. Pressure may be felt as the scope advances through the esophagus into the stomach. Feelings of bloating but not pain are common.
- The procedure lasts about 40 minutes.
- Results are normally available within 24 hours.
- Complications in elderly include arrhythmia, elevated blood pressure >50 mm Hg, increased pulse rate, and decreased oxygen saturation.
Factors That Affect Results
- If the client moves excessively during the procedure, the risk of perforation is increased.
- Emergency EGD diagnostic accuracy is 80%–85%.