Name of the Procedure:

Esophagogastroduodenoscopy, flexible, transoral; with esophagogastric fundoplasty, partial or complete, includes duodenoscopy when performed

Summary

Esophagogastroduodenoscopy, commonly known as an EGD, is a diagnostic procedure where a flexible tube with a camera is inserted through the mouth to examine the esophagus, stomach, and duodenum. When combined with esophagogastric fundoplasty, it involves reshaping or tightening the top part of the stomach to prevent acid reflux. This procedure includes viewing the duodenum when necessary.

Purpose

Medical Conditions Addressed:

• Gastroesophageal reflux disease (GERD)
• Hiatal hernia
• Esophagitis
• Gastric or duodenal ulcers

Goals:

• To diagnose and treat conditions causing symptoms like heartburn or acid reflux.
• To repair the esophagogastric junction to prevent reflux.

Indications

• Persistent acid reflux not relieved by medication.
• Symptoms of GERD such as heartburn, regurgitation, chest pain.
• Inflammation or irritation of the esophagus.
• Complications from prior GERD treatment.

Preparation

• Fasting for at least 6-8 hours before the procedure.
• Adjusting certain medications as instructed by your doctor.
• Undergoing pre-operative evaluations such as blood tests or imaging studies.

Procedure Description

1. Anesthesia: Administering sedatives or general anesthesia to ensure comfort.
2. Insertion: A flexible endoscope is gently inserted through the mouth into the esophagus, stomach, and duodenum.
3. Inspection: The doctor examines these areas for abnormalities.
4. Fundoplasty:
   • Partial Fundoplasty: The top part of the stomach is wrapped partially around the lower esophagus.
   • Complete Fundoplasty: The entire top part of the stomach is wrapped around the lower esophagus, creating a tighter valve to prevent reflux.
5. Completion: The endoscope is removed once the procedure is complete.

Tools and Equipment:

• Flexible endoscope with a camera.
• Surgical tools for fundoplasty.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

Performed in a hospital or an outpatient surgical center.

Personnel

• Gastroenterologist or Surgeon
• Anesthesiologist
• Nurses and Surgical Technicians

Risks and Complications

Common Risks:

• Sore throat
• Minor bleeding

Rare Complications:

• Infection
• Perforation of the esophagus, stomach, or duodenum
• Adverse reaction to anesthesia
• Difficulty swallowing

Benefits

• Relief from GERD symptoms.
• Reduced risk of esophageal damage from acid reflux.
• Improvement in quality of life.
• Benefits typically realized within a few weeks post-procedure.

Recovery

• Monitoring in a recovery room until the effects of anesthesia wear off.
• Gradual reintroduction of fluids and solids as tolerated.
• Post-procedure instructions on diet, activity level, and medication use.
• Follow-up appointments to monitor recovery.
• Typical recovery time is several weeks with some activity restrictions.

Alternatives

• Medication management (e.g., proton pump inhibitors)
• Lifestyle modifications (dietary changes, weight loss)
• Other surgical options like Nissen Fundoplication

Pros and Cons:

• Medication: Less invasive but may not be effective long-term.
• Lifestyle Changes: Non-invasive, requires commitment and may not fully control symptoms.
• Alternative Surgeries: Vary in invasiveness and effectiveness.

Patient Experience

During the Procedure:

• Anesthesia ensures the patient remains comfortable and pain-free.

After the Procedure:

• Possible sore throat and mild discomfort.
• Pain medication and care instructions provided.
• Follow-up to ensure proper healing and symptom resolution.