Overview of Esophagogastroduodenoscopy

Esophagogastroduodenoscopy (EGD) is a process used for diagnosing problems in the digestive system. In this process, a doctor takes a close look at parts of your body like the back of your mouth (oropharynx), the tube that connects your throat to your stomach (esophagus), your stomach, and the first part of your small intestine (proximal duodenum). It’s often done by a kind of doctor who specializes in digestive issues, known as a gastroenterologist, and is one of the most common procedures they perform.

Anatomy and Physiology of Esophagogastroduodenoscopy

The esophagus is the tube that carries food from your mouth to your stomach. It is located behind the windpipe (trachea) and starts after the ring-like cartilage in the throat (cricoid cartilage), proceeding until it meets the stomach. The length of the esophagus varies, ranging from 9 to 10 cm in a newborn baby, growing to about 25 cm in adults. You can see where the throat turns into the stomach because the color of the inner lining of the esophagus changes from a faint color to a richer pink. This is known as the Z line.

Let’s talk about the stomach next. The stomach is typically situated beneath the diaphragm, a muscle that helps in breathing, and is about 40 cm away from your front teeth (incisors) in an adult. The part of the stomach that the esophagus feeds into is named the gastric cardia. The section of the stomach above where the esophagus and the stomach come together is known as the fundus. There’s a part of the stomach called the body, which makes up the majority of the stomach. The part called the incisura separates the body from the antrum and is located along the inner curve of the stomach. When a camera is used to view the stomach from the inside, the lining of the stomach (mucosa) flattens out as the body transitions into the antrum. Lastly, we have the pylorus, which is like a muscular gateway from the stomach to the beginning of the small intestine (duodenum).

Now, onto the duodenum, which is the initial part of the small intestine, stretching from the pylorus to the start of the next part of the intestine (jejunum), at a point called the duodenojejunal angle. The duodenum has a bulge just after the pylorus, known as the duodenum bulb. After the bulb, the tube of the duodenum bends backwards and to the right for about 2.5 cm, then downwards for 7.5 to 10 cm, and finally turns forwards and to the left for around 2.5 cm before it connects to the jejunum. This junction is marked by a structure called the ligament of Treitz.

Why do People Need Esophagogastroduodenoscopy

If you consistently experience pain in the upper part of your stomach, or pain accompanied by symptoms like weight loss or lack of appetite, you might need certain medical procedures. Other indications are difficulty swallowing, long-lasting or unmanageable symptoms of GERD (Gastroesophageal Reflux Disease – a condition that causes heartburn due to stomach acid flowing back into the esophagus), or unexplainable restlessness in a child.

Consistent vomiting of unknown cause or vomiting blood also calls for these procedures. Another indication is iron deficiency anemia that might result from chronic blood loss, especially when it looks like your upper gastrointestinal (GI) tract – the part of your body where digestion starts, may be the source of blood loss, or when a colonoscopy (a test to examine your colon) turns out normal.

Other symptoms include long-lasting diarrhea or issue with nutrient absorption in your body, needing to evaluate damage after swallowing a harmful substance, or being under the watchful eye for cancer in patients with disease conditions that may turn into cancer like polyposis syndromes (a condition where multiple polyps grow in your colon), previous ingestion of harmful substances or Barrett’s esophagus (a condition where the tissue lining your esophagus changes to tissue similar to the lining of your intestine).

There are also therapeutic procedures to undertake as well. These include removal of foreign bodies, widening or placing a stent (a small tube to hold the passageway open) in strictures (a narrow section in your esophagus), tying off enlarged blood vessels in your esophagus, controlling upper GI bleeding, or placing feeding or drainage tubes.

Management of achalasia (a disorder of your esophagus making it hard for food and liquid to pass into your stomach) can involve injecting botulinum toxin or using a balloon dilation (a procedure that widens a narrow section of your esophagus).

When a Person Should Avoid Esophagogastroduodenoscopy

There are a few specific conditions that would absolutely prevent a doctor from performing certain procedures:

– If the bowel has holes in it (perforated bowel),
– If the person has peritonitis, which is inflammation in the lining of the inner wall of the abdomen caused by an infection,
– If the person is unstable and has toxic megacolon, a condition where the large intestine suddenly swells.

There are also conditions that make the procedure potentially dangerous but don’t strictly prohibit it:

– If the person has severe neutropenia, a condition that reduces the number of white blood cells in the body, which can make it harder to fight infections,
– If the person has coagulopathy, a condition where their blood doesn’t clot properly,
– If the person has a low platelet count (severe thrombocytopenia) or their platelets don’t function properly, which can lead to excessive bleeding,
– If there is an increased risk of perforation, or making holes in, the bowel, which could be caused by conditions that affect connective tissue, recent bowel surgery, or bowel obstruction,
– If the person has an abdominal or iliac aorta aneurysm, which is a dangerous bulge in the main artery that supplies blood to the body.

Equipment used for Esophagogastroduodenoscopy

Gastroscopes are medical instruments used by doctors to examine your stomach and upper digestive tract. Regularly used gastroscopes are approximately 10mm in diameter, with an inner pathway of 2.8 mm for tiny instruments to pass through. However, for small children who weigh less than 10 kg, doctors will use even smaller gastroscopes, smaller than 6mm, for safety.

If there is a severe case of upper digestive tract bleeding, your doctor may use a slightly larger gastroscope, between 3.8 to 4.2 mm in diameter. These scopes have a larger inner channel for special procedures and tools. In case the doctor is inspecting your stomach for signs of cancer or other serious illness, high-definition gastroscopes with the ability to zoom can be used to provide a clearer view of the stomach lining.

There are various kinds of tools or “accessories” that can be used during the process. Biopsy forceps, which come in standard and larger sizes, are used to take small tissue samples from the digestive tract. If any objects got stuck in the digestive tract and need to be removed, the doctor might use ‘rat-tooth’ or ‘alligator’ forceps, a retrieval net, or a snare specially designed for polyp removal. For these procedures, protective gear, like overtubes and a special hood, are available to safeguard the esophagus and stomach. Depending on the complexity of the procedure, additional equipment could be necessary.

Preparing for Esophagogastroduodenoscopy

Endoscopy, an examination method that uses an instrument to see inside the body, is typically done for both children and adults as an outpatient procedure. This means it’s done outside of the hospital and doesn’t require an overnight stay. In some cases, it’s necessary to do the endoscopy at the hospital or even in an operating room.

For a planned upper endoscopy, certain preparations are necessary, including fasting or not eating for a period of time. According to the American Society for Anesthesiologists (ASA), patients should stop eating clear liquids at least 2 hours and light meals at least 6 hours before the procedure. For emergency situations or where the stomach is taking longer to empty its contents, doctors need to be extra careful to prevent contents of the stomach from getting into the lungs, which can cause a serious condition known as aspiration. They’ll decide whether to adjust sedation levels, consider placing a tube down the throat for breathing, or even postpone the procedure until it’s safe.

Most medications can still be taken before an endoscopy, often with a small sip of water. However, people with diabetes may need to adjust their medications because they can’t eat before the procedure. The American Society for Gastrointestinal Endoscopy (ASGE) has guidelines for handling blood-thinning drugs and deciding whether to administer antibiotics to at-risk patients before the endoscopy.

Sedatives, or medication that helps patients relax or sleep, are typically used for endoscopies to minimize discomfort and help patients forget about the procedure. Before the procedure, everyone should be evaluated for their risk to sedation and any potential problems related to their existing health conditions. The choice of sedation can vary between mild conscious sedation to more monitored anesthesia care. Many endoscopists prefer to use an intravenous sedative such as propofol for routine upper endoscopies. For procedures like removal of foreign objects or in scenarios where the patient might not be cooperative like with young children, general anesthesia might be needed. The ASGE recommends regular monitoring of vital signs and watching for changes in heart and lung function during all endoscopic procedures performed under sedation.

Lastly, informed consent is crucial. This means that the patient, parents, or legal guardians should understand and agree to the scope (known as Esophagogastroduodenoscopy or EGD) and sedation procedures.

How is Esophagogastroduodenoscopy performed

Using the Endoscope

An endoscope is a slender, flexible tube with a light and camera at its tip which allows the doctor to see inside your body. Usually, the doctor holds the endoscope in the left hand with its control part fitting snugly in their palm. Their thumb controls the endoscope’s movements, while their index and middle fingers operate the suction, air, and water valves. The doctor uses their right hand to move the endoscope forward and backward and to insert tools like biopsy forceps, brushes, and needles.

Esophageal Intubation 

Esophagogastroduodenoscopy (EGD) is an examination of your esophagus (food pipe), stomach, and the top part of your small intestine (duodenum). For this test, you would usually lie on your left side with your neck bent forward. A mouth guard is placed to protect your teeth before inserting the endoscope. The endoscope is gently guided towards the back of your mouth where it will then be directed downwards to access your vocal cords and esophagus. This process often involves making the endoscope tip go down and puffing some air.

Checking The Esophagus and Esophagogastric junction

Once the endoscope enters the esophagus, it is moved further down while checking for any inflammation, ulcers, outgrowths, or narrowing. The junction of the esophagus and the stomach should be noted. This junction (‘Z-line’) is where the lining of your esophagus meets the lining of your stomach. If this junction is not in its usual place, a biopsy may be performed to check for a condition called Barrett’s esophagus.

Examining the Stomach

The endoscope is fed further to enter the stomach. Any remaining gastric juices will be sucked out and air is puffed in to get a better view inside the stomach. With the endoscope near the pylorus (the passage that leads from the stomach to the duodenum), the stomach is filled and the endoscope is pushed gently into the pylorus to check inside.

Checking the Duodenum

Once the endoscope passes through the pylorus, it enters the duodenum bulb (the first part of the duodenum). The walls of the duodenum bulb should be examined on insertion to catch any potential alterations caused by the scope. Once the duodenum bulb is studied, the endoscope is further navigated through the lower parts of the duodenum, maintaining a clear view of the luminal space. This action also helps to straighten out formed loops in the stomach and lets the endoscope progress into the farthest possible parts of the duodenum.

The lower parts of the duodenum have distinctive circular patterns called valvulae conniventes. The ampulla of Vater, an opening in the duodenum through which bile and pancreatic juices enter, is found here and can be checked during the withdrawal of the endoscope.

After checking the duodenum, the pylorus, and the antrum (the lower part of the stomach), the endoscope is turned back to check the top of the stomach. The endoscope is slid back along the direction of insertion, and the entire stomach is checked again before removing the endoscope. Before leaving the stomach, the air puffed into the stomach is sucked out. The esophagus is also rechecked while the endoscope is being removed.

A complete diagnostic EGD typically takes 5 to 10 minutes under optimal sedation conditions. During the EGD, tissue samples could be collected for lab testing. In case of a normal looking but symptomatic patient, routine biopsies from designated areas can be performed. Captured samples may include biopsies, brushings of the inner surface, and small tumor removals. These samples are sent for further detailed checks depending on the patient’s symptoms and the type of sample obtained.

Possible Complications of Esophagogastroduodenoscopy

Problems following an esophagogastroduodenoscopy (EGD), a procedure where a doctor examines your esophagus, stomach, and upper part of your small intestine using a thin tube with a camera, are rare. Less than 2% of patients experience complications. These can result from the sedation, the endoscopy itself, or any tests or treatments performed during the procedure.

When sedation – a relaxing medication is used, the most common and serious concerns involve the heart and lungs. Over-sedation could lead to low levels of oxygen in the blood (hypoxemia), decreased respiratory rate (hypoventilation), low blood pressure (hypotension), difficulty in breathing (airway obstruction), irregular heart rate (arrhythmias), and food or liquid entering the lungs (aspiration).

Complications from the EGD procedure can include infection, bleeding, duodenal hematoma (a bruise in the duodenum, or the first part of the small intestine), and bowel perforation (a hole in the bowel). Bleeding after an EGD procedure with a biopsy – the removal of a small piece of tissue for testing, happens in 0.3% of cases. This could lead to blood inside the digestive tract or a bruise inside the digestive tract. The occurrence of a duodenal hematoma is a rare complication of an EGD and seems to occur more often in children than adults. Bowel perforation occurs in less than 0.3% of cases, and infections are very rare.

Most complications are identified in the first 24 hours after the procedure. Bleeding can cause vomiting blood or bloody drainage from the stomach tube. A bowel perforation might be discovered through symptoms like fever, rapid heart rate, or abdominal pain or discomfort. An abdominal x-ray can show if there’s air outside of the digestive tract – a sign of perforation. Resting the bowels and taking antibiotics is the usual treatment, although in some cases, surgery may be required.

What Else Should I Know About Esophagogastroduodenoscopy?

Esophagogastroduodenoscopy (EGD), a medical procedure where a small tube with a camera on the end is passed down your throat to examine your digestive system, is a crucial way doctors diagnose and treat issues in the esophagus (the tube that carries food from your mouth to your stomach), stomach, and the initial part of the small intestine. This procedure is typically used when patients experience trouble swallowing, stomach bleeds, stomach ulcers, acid reflux that doesn’t respond to medication, narrow esophagus, celiac disease (an autoimmune disorder related to eating gluten), and unexplained diarrhea.

During an EGD, a doctor can collect tissue samples for further testing and perform treatments like stopping a bleed or widening a narrowed esophagus. This is generally a safe procedure that is tolerated well by patients.

In recent times, the use of EGD in children has been on the rise. However, the decision-making process concerning the situations and timing for an EGD in children is more nuanced and requires careful consideration to ensure we get the best results and minimize any risk.

Frequently asked questions

1. What symptoms or conditions indicate that I may need an Esophagogastroduodenoscopy (EGD)? 2. What preparations do I need to make before the EGD procedure? 3. What are the potential risks or complications associated with EGD? 4. What kind of sedation will be used during the procedure and what are the potential side effects? 5. What will happen during the EGD procedure and what can I expect afterwards?

Esophagogastroduodenoscopy (EGD) is a procedure that allows doctors to examine the esophagus, stomach, and duodenum using a flexible tube with a camera. During the procedure, the tube is inserted through the mouth and down the throat to reach these areas. EGD can help diagnose and treat various conditions, such as ulcers, inflammation, and tumors, and it may cause some discomfort or side effects, but these are generally temporary.

Esophagogastroduodenoscopy (EGD) may be necessary for several reasons. Some common indications for EGD include: 1. Evaluation of gastrointestinal symptoms: EGD can help diagnose the cause of symptoms such as persistent heartburn, difficulty swallowing, abdominal pain, nausea, vomiting, or unexplained weight loss. 2. Diagnosis and monitoring of gastrointestinal diseases: EGD is commonly used to diagnose conditions like gastroesophageal reflux disease (GERD), peptic ulcers, gastritis, esophagitis, Barrett's esophagus, celiac disease, and certain types of cancer. It can also be used to monitor the progression or treatment response of these conditions. 3. Screening for certain conditions: EGD is recommended as a screening tool for individuals at high risk of developing esophageal or gastric cancer, such as those with long-standing GERD, Barrett's esophagus, or a family history of these cancers. 4. Treatment of gastrointestinal bleeding: EGD allows for the identification and treatment of the source of gastrointestinal bleeding, such as ulcers or abnormal blood vessels. 5. Removal of polyps or foreign objects: EGD can be used to remove polyps (abnormal growths) from the esophagus, stomach, or duodenum. It can also be used to retrieve swallowed objects that have become lodged in the digestive tract. It is important to consult with a healthcare professional to determine if EGD is necessary in your specific case.

You should not get an Esophagogastroduodenoscopy if you have conditions such as a perforated bowel, peritonitis, toxic megacolon, severe neutropenia, coagulopathy, low platelet count, increased risk of bowel perforation, or an abdominal or iliac aorta aneurysm, as these conditions can make the procedure potentially dangerous or impossible to perform.

The text does not provide information about the recovery time for Esophagogastroduodenoscopy.

To prepare for an Esophagogastroduodenoscopy (EGD), you may need to fast for a certain period of time before the procedure. This typically involves not eating clear liquids for at least 2 hours and light meals for at least 6 hours prior to the procedure. It is important to follow any specific fasting instructions provided by your doctor.

The complications of Esophagogastroduodenoscopy (EGD) include problems related to sedation such as low oxygen levels, decreased respiratory rate, low blood pressure, difficulty in breathing, irregular heart rate, and aspiration. Complications from the procedure itself can include infection, bleeding, duodenal hematoma, and bowel perforation. Bleeding after a biopsy occurs in 0.3% of cases, duodenal hematoma is a rare complication, and bowel perforation occurs in less than 0.3% of cases. Most complications are identified within 24 hours after the procedure, and symptoms may include vomiting blood, bloody drainage from the stomach tube, fever, rapid heart rate, abdominal pain, or discomfort. Treatment usually involves resting the bowels and taking antibiotics, but surgery may be required in some cases.

Symptoms that require Esophagogastroduodenoscopy include pain in the upper part of the stomach, difficulty swallowing, long-lasting or unmanageable symptoms of GERD, consistent vomiting of unknown cause or vomiting blood, iron deficiency anemia resulting from chronic blood loss, long-lasting diarrhea or issues with nutrient absorption, evaluating damage after swallowing a harmful substance, being under surveillance for cancer in patients with disease conditions that may turn into cancer, and therapeutic procedures such as removal of foreign bodies, widening or placing a stent in strictures, tying off enlarged blood vessels, controlling upper GI bleeding, or placing feeding or drainage tubes.

The safety of Esophagogastroduodenoscopy (EGD) in pregnancy is not specifically addressed in the provided text. Therefore, it is recommended to consult with a healthcare professional to assess the potential risks and benefits of the procedure in the context of pregnancy.

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