43239 Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple

Name of the Procedure:

Esophagogastroduodenoscopy (EGD), flexible, transoral; with biopsy, single or multiple.

Summary

An esophagogastroduodenoscopy (EGD) is a diagnostic procedure where a flexible tube with a camera (endoscope) is inserted through the mouth to examine the lining of the esophagus, stomach, and the first part of the small intestine (duodenum). During this procedure, the doctor may take one or more tissue samples (biopsies).

Purpose

Medical Conditions Addressed:

• Gastroesophageal reflux disease (GERD)
• Barrett's esophagus
• Ulcers
• Tumors
• Inflammation

Goals and Outcomes:

• Diagnose the cause of symptoms such as abdominal pain, nausea, vomiting, or difficulty swallowing.
• Assess the extent of gastrointestinal disease.
• Collect tissue samples to detect infections, cancer, or other conditions.

Indications

Symptoms or Conditions:

• Persistent heartburn or acid reflux
• Unexplained chest pain
• Difficulty swallowing (dysphagia)
• Chronic nausea and vomiting
• Gastrointestinal bleeding
• Black or tarry stools

Patient Criteria:

• Individuals with unexplained gastrointestinal symptoms not resolved with initial treatment.
• Patients with a known condition requiring periodic surveillance (e.g., Barrett's esophagus).

Preparation

• Fast (no food or drink) for at least 6-8 hours before the procedure.
• Adjust or stop certain medications as directed by the healthcare provider.
• May require blood tests or other diagnostics before the procedure.

Procedure Description

1. The patient may receive a sedative and pain killers to ensure comfort.
2. A mouthguard is placed to protect the teeth and endoscope.
3. The endoscope is gently inserted through the mouth and guided through the esophagus, stomach, and duodenum.
4. Air is introduced to expand the area for better visibility.
5. The doctor examines the mucosa and may take one or multiple tissue biopsies.
6. The endoscope is carefully removed after the examination.

Tools and Equipment:

• Flexible endoscope with a camera and light source
• Biopsy forceps for tissue sampling

Anesthesia or Sedation:

• Local anesthetic to the throat (spray)
• Sedation to help the patient relax and reduce discomfort

Duration

The procedure typically takes about 15 to 30 minutes.

Setting

An EGD is usually performed in a hospital, outpatient clinic, or specialized endoscopy center.

Personnel

• Gastroenterologist or specialized physician
• Registered nurse
• Anesthesiologist or nurse anesthetist (if sedation is used)

Risks and Complications

Common Risks:

• Sore throat
• Mild bloating
• Nausea

Rare Complications:

• Bleeding from the biopsy site
• Infection
• Perforation of the gastrointestinal tract
• Adverse reaction to sedation

Benefits

• Accurate diagnosis of gastrointestinal issues.
• Early detection and treatment of serious conditions.
• Symptom relief through targeted therapy.

Realized Benefits Timeline:

• Diagnostic results often available within a few days.
• Treatment and symptom relief can begin immediately following diagnosis.

Recovery

Post-procedure Care:

• Rest until sedation effects wear off.
• Avoid eating or drinking until gag reflex returns (approximately 1-2 hours).
• Follow specific dietary instructions.
• Arrange for someone to drive the patient home.

Recovery Time:

• Full recovery typically within a day.
• Minor throat discomfort or bloating may last a couple of days.

Follow-up:

• Review biopsy results with the physician.
• Additional tests or treatment as advised.

Alternatives

Other Treatment Options:

• Barium swallow X-ray
• CT or MRI scans
• Capsule endoscopy

Pros and Cons:

• EGD provides direct visualization and biopsy capability which some other tests may not.
• Capsule endoscopy is less invasive but cannot perform biopsies.

Patient Experience

During the Procedure:

• Minimal discomfort due to sedation.
• Possible mild gagging during the insertion of the endoscope.

After the Procedure:

• Slight soreness in the throat.
• Feelings of bloating or gas for a short period.

Pain Management:

• Over-the-counter pain relievers for any residual throat discomfort.
• Follow-up with the healthcare provider if significant discomfort persists.