43235 Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)

Name of the Procedure:

Esophagogastroduodenoscopy (EGD), flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure).

Summary

Esophagogastroduodenoscopy, commonly known as EGD, is a diagnostic procedure in which a flexible endoscope is inserted through the mouth to examine the esophagus, stomach, and the duodenum (the first part of the small intestine). During the procedure, specimens may be collected via brushing or washing for further analysis.

Purpose

Medical Condition:

EGD is used to diagnose conditions such as gastrointestinal bleeding, persistent heartburn, chronic nausea, vomiting, abdominal pain, difficulty swallowing, and unexplained weight loss.

Goals:

The goal is to identify abnormalities in the upper gastrointestinal tract and obtain tissue samples if necessary, allowing for accurate diagnosis and subsequent treatment planning.

Indications

EGD is indicated for patients with symptoms like:

• Persistent upper abdominal pain
• Gastroesophageal reflux disease (GERD)
• Difficulty swallowing (dysphagia)
• Chronic nausea and vomiting
• Unexplained weight loss
• Suspected upper gastrointestinal bleeding

Preparation

• Patients are typically advised to fast for 6-8 hours prior to the procedure.
• Medication adjustments may be necessary; certain blood thinners or diabetes medications might need to be temporarily stopped.
• Pre-procedure diagnostic tests such as blood work or imaging studies may be required.

Procedure Description

1. Sedation: The patient is given sedatives to ensure comfort.
2. Insertion: A flexible endoscope is gently inserted through the mouth and guided down the throat.
3. Examination: The physician examines the lining of the esophagus, stomach, and duodenum using the endoscope camera.
4. Specimen Collection: If necessary, specimens are collected by brushing or washing the area of interest.
5. Completion: The endoscope is carefully withdrawn, and any immediate findings are discussed with the patient after they wake up from sedation.

Tools used include the flexible endoscope with a camera, biopsy forceps, brushes, and washing tools.

Duration

The procedure typically takes about 15-30 minutes.

Setting

EGD is usually performed in a hospital endoscopy suite, outpatient clinic, or surgical center with specialized equipment.

Personnel

The procedure is conducted by a gastroenterologist, with assistance from nurses and possibly an anesthesiologist if deeper sedation is required.

Risks and Complications

• Common Risks: Sore throat, bloating, mild cramping.
• Rare Complications: Perforation of the gastrointestinal tract, bleeding, adverse reaction to sedation, infection. Most complications are managed promptly by the medical team.

Benefits

• Expected Benefits: Accurate diagnosis of gastrointestinal issues, early detection of conditions like ulcers, cancer, or inflammation.
• Realization: Benefits are usually immediate if diagnostic information is obtained; tissue sample analysis may take a few days.

Recovery

• Post-Procedure Care: Monitoring until sedatives wear off, fluids can be resumed shortly after, gradually returning to normal diet.
• Recovery Time: Typically a few hours post-procedure, with most individuals resuming normal activities the next day.
• Instructions: Patients may be advised to avoid strenuous activities for 24 hours and arrange for someone to drive them home.

Alternatives

• Other Options: Barium swallow, CT scan, or MRI of the abdomen.
• Pros and Cons: These alternatives may be less invasive but lack the detailed visualization and ability to collect tissue samples provided by EGD.

Patient Experience

• During Procedure: Patients are generally sedated and feel minimal discomfort.
• After Procedure: Some may experience a mild sore throat or bloating, which usually resolves within 24 hours. Pain management includes over-the-counter pain relievers and comfort measures like throat lozenges or warm fluids.