Esophagogastroduodenoscopy Procedure

Introduction

An Esophagogastroduodenoscopy (EGD), commonly known as an upper endoscopy, is a medical procedure used to examine the lining of the esophagus, stomach, and the first part of the small intestine (duodenum). This procedure is instrumental in diagnosing and treating various conditions affecting the upper gastrointestinal tract.

Purpose of EGD

The EGD procedure is performed for several reasons, including but not limited to:

• Diagnosis: EGD helps in diagnosing conditions such as GERD (Gastroesophageal Reflux Disease), ulcers, tumors, inflammation, and celiac disease. It is also used to investigate the cause of symptoms like abdominal pain, bleeding, nausea, vomiting, and difficulty swallowing.
• Treatment: It allows for the removal of polyps, dilation of narrowed areas, and treatment of bleeding lesions. Additionally, foreign objects can be retrieved, and feeding tubes can be placed.

Preparation for the Procedure

Proper preparation for an EGD is crucial for ensuring the procedure’s effectiveness and patient safety.

Pre-procedure Instructions

Patients are usually advised to:

• Fasting: Refrain from eating or drinking for at least 6-8 hours before the procedure to ensure the stomach is empty.
• Medication Adjustment: Inform the doctor about all medications being taken. Some medications might need to be adjusted or temporarily stopped.
• Consent: Provide informed consent after understanding the procedure, risks, and benefits.

The EGD Procedure

The EGD procedure is typically performed on an outpatient basis and involves the following steps:

Sedation

Patients are given a sedative to help them relax and reduce discomfort. A local anesthetic may also be sprayed into the throat to numb the area.

Insertion of the Endoscope

A flexible tube called an endoscope, equipped with a light and camera, is gently inserted through the mouth and guided down the esophagus, stomach, and duodenum. The endoscope transmits images to a monitor, allowing the doctor to examine the lining of these organs.

Biopsies and Treatments

If necessary, small instruments can be passed through the endoscope to take tissue samples (biopsies) or perform treatments such as removing polyps, cauterizing bleeding vessels, or dilating strictures.

Post-procedure Care

After the EGD, patients are monitored until the effects of the sedative wear off. It is normal to experience a mild sore throat, bloating, or gas for a few hours following the procedure.

Recovery and Aftercare

• Observation: Patients are usually observed for a short period to ensure there are no immediate complications.
• Diet: Most patients can resume their normal diet and activities within a few hours, although it is recommended to start with light meals.
• Results: The doctor will discuss the findings and any necessary follow-up care or treatment based on the results of the endoscopy.

Risks and Complications

While an EGD is generally safe, there are potential risks and complications, including:

• Perforation: A small risk of tearing the lining of the esophagus, stomach, or duodenum.
• Bleeding: Particularly if a biopsy is taken or a polyp is removed.
• Infection: Though rare, there is a slight risk of infection.
• Adverse Reaction to Sedation: Potential complications from the sedative used during the procedure.

Nursing Care of Patient with EGD Procedure (Upper Endoscopy)

An Esophagogastroduodenoscopy (EGD), commonly referred to as an upper endoscopy, is a procedure used to examine the lining of the esophagus, stomach, and the first part of the small intestine (duodenum). Proper nursing care is essential for ensuring patient safety, comfort, and successful outcomes.

A.Pre-Procedure Care

Patient Assessment

• Medical History: Obtain a detailed medical history, including allergies, current medications, and any previous reactions to sedation or anesthesia.
• Physical Examination: Conduct a thorough physical examination, focusing on the gastrointestinal system.
• Consent: Ensure that the patient understands the procedure, risks, benefits, and alternatives, and has signed the informed consent form.

Patient Preparation

• Fasting: Instruct the patient to fast for 6-8 hours before the procedure to ensure the stomach is empty.
• Medication Instructions: Advise on which medications to continue or halt before the procedure, especially anticoagulants and antiplatelets.
• Education: Explain the procedure, what to expect, and post-procedure care to alleviate any anxiety or concerns.

B. Intra-Procedure Care

Monitoring and Support

• Vital Signs: Continuously monitor the patient’s vital signs, including heart rate, blood pressure, oxygen saturation, and respiratory rate.
• Comfort: Provide emotional support and reassurance to the patient throughout the procedure.
• Sedation: Administer and titrate sedation as ordered, and monitor for any adverse reactions.

Assistance During Procedure

• Positioning: Assist in positioning the patient appropriately, usually in the left lateral position.
• Equipment: Ensure that all necessary equipment and supplies are available and functioning properly.
• Documentation: Keep accurate records of the procedure, including medications administered, patient responses, and any complications.

C. Post-Procedure Care

Immediate Recovery

• Observation: Observe the patient in the recovery area for any immediate complications, such as bleeding, perforation, or adverse reactions to sedation.
• Vital Signs: Monitor vital signs at regular intervals until the patient is fully awake and stable.
• Comfort Measures: Provide comfort measures such as a warm blanket, and address any pain or discomfort.

Patient Instructions

• Diet: Advise the patient to start with light meals and gradually resume a normal diet as tolerated.
• Activity: Encourage the patient to rest for the remainder of the day and avoid strenuous activities.
• Hydration: Ensure the patient stays well-hydrated, especially if they had a biopsy or polyp removal.

D. Follow-Up Care

• Results Discussion: The doctor will discuss the findings and any necessary follow-up care or treatment based on the results of the endoscopy.
• Complication Signs: Instruct the patient to report signs of complications, such as persistent pain, fever, vomiting, or unusual bleeding.
• Appointments: Schedule any necessary follow-up appointments or additional testing.

Risks and Complications

While an EGD is generally safe, there are potential risks and complications, including:

• Perforation: A small risk of tearing the lining of the esophagus, stomach, or duodenum.
• Bleeding: Particularly if a biopsy is taken or a polyp is removed.
• Infection: Though rare, there is a slight risk of infection.
• Adverse Reaction to Sedation: Potential complications from the sedative used during the procedure.

REFERENCES

1. Ahlawat R, Hoilat GJ, Ross. Esophagogastroduodenoscopy. (https://www.ncbi.nlm.nih.gov/books/NBK532268/). 2023 Aug 8. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan.
2. Feldman M, et al., eds. Preparation for and complications of gastrointestinal endoscopy. In: Sleisenger and Fordtran’s Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 11th ed. Elsevier; 2021. https://www.clinicalkey.com.
3. Upper GI endoscopy. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/diagnostic-tests/upper-gi-endoscopy.
4. American College of Gastroenterology. Upper GI endoscopy (EGD) (https://gi.org/topics/upper-gi-endoscopy-egd/). Published 9/2018.
5. National Library of Medicine (U.S.). EGD – esophagogastroduodenoscopy(https://medlineplus.gov/ency/article/003888.htm). Last reviewed 8/7/2023.

Stories are the threads that bind us; through them, we understand each other, grow, and heal.

JOHN NOORD

Connect with “Nurses Lab Editorial Team”

I hope you found this information helpful. Do you have any questions or comments? Kindly write in comments section. Subscribe the Blog with your email so you can stay updated on upcoming events and the latest articles.