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An Endoscopy is a procedure that uses an endoscope, a long flexible tube that features a light and camera, for the purpose of internally inspecting organs in the body in order to diagnose or treat a condition. An endoscopy procedure can be used to treat or diagnose many health problems within the body. However, a specific procedure known as an Esophagogastroduodenoscopy (EGD ) - usually called an Upper Endoscopy - is a procedure that uses an endoscope to examine the inside of the upper gastrointestinal tract - esophagus, stomach, and duodenum (first part of the small bowel).
When is an upper endoscopy recommended? This procedure is usually performed to evaluate potential problems that occur within the esophagus, stomach or duodenum. It is usually recommended for people who experience unexplained symptoms of:
- Upper abdominal pain
- Dysphagia (difficulty swallowing)
An EGD is more accurate than an x-ray when it comes to detecting inflammation, ulcers, or tumors in the upper gastrointestinal tract.
In addition, an upper endoscopy may be recommended if a biopsy (collection of a small piece of tissue) or cytology (collection of some cells with a fine brush) is required. The Biopsy and cytology samples are subjected to microscopic examination to determine if questionable tissue or cells are benign (non cancerous) or malignant (cancerous). That being said, biopsies are taken for a variety of reasons, and are not exclusive for determining suspected cancerous or precancerous cells.
An EGD may also be recommended for people who require treatment for certain conditions such as:
- Stretching strictures (abnormal narrowing in the esophagus)
- Removing benign growths (I.E. polyps, objects that have been swallowed accidentally, etc.)
- Upper gastrointestinal bleedings from ulcers or lining tears (this helps to eliminate the need for blood transfusions or surgeries)
How is an upper endoscopy performed? A specialist trained and experienced in endoscopic procedure, such as a gastroenterologist, will perform the procedure. The physician doing the procedure will spray the patient’s throat with a local anesthetic to make swallowing the endoscope easier. In addition to the local anesthetic, the patient may also be given a sedative and pain relieving medication intravenously through their hand. This helps to relax the patient during the procedure.
The patient lies on their left side, and a special mouthpiece is inserted in the mouth that does not obstruct breathing. The physician will then ask the patient to swallow the first part of the endoscope. Swallowing usually feels strange and uncomfortable. The physician will then proceed to slide the device down the throat into the esophagus, stomach and duodenum.
Once the endoscope reaches the patient’s stomach, air is blown into the stomach to enable the physician to see red patches, lumps, holes, blockages, or any other abnormalities, which is transmitted from the camera on the endoscope to a TV monitor screen.
If the physician detects any abnormal areas, a biopsy can be taken. The patient should not feel the biopsy.
Once everything has been inspected and all samples are taken, the endoscope is removed. Patients feel only minor discomfort during the procedure, and it is quite common for a patient who has been given a sedative to sleep throughout most of the endoscopy. At no time during the procedure will the endoscope interfere with the patient’s breathing. The entire procedure usually lasts 15 – 20 minutes.
What can I expect after the procedure?
Recovery - After the procedure, patients are given time to rest in the recovery room where they are observed for 30 minutes or over a few hours (depending on how long it takes for a sedative to wear off, everyone responds differently). EGD is an outpatient procedure; patients are sent home the same day unless under extremely rare circumstances complications occur in which a patient would remain in hospital.
After undergoing EGD, a responsible adult should drive the patient home, and the patient is to rest and not drive or operate heavy machinery for at least 8 hours after the procedure.
Side effects - Patients should expect very minor symptoms from the procedure such as a mild sore throat caused by the endoscope or a feeling of distention that results from the air used during procedure. Both problems are extremely mild and last for only a brief time.
Results - After recovery, patients should expect the results of their EGD in the recovery room, and will be provided with probable findings. However, patients who had a biopsy or cytology will normally receive results within 72 – 96 hours. Patients should be advised that initial results given are probable findings or presumptions, as more definitive results are discovered later.
What should I do to prepare for the upper endoscopy? First of all, you should talk to your physician to learn about everything that is involved in the procedure and what is expected of you. That being said, in order to prepare for an EGD the following is usually required of patients:
- Inform the doctor of any allergies, health problems, or any medications you are taking. The doctor should also be informed if you are pregnant.
- Refrain from eating or drinking 6 hours before the procedure so that the examination will be safe and complete.
- You will need to have a responsible adult drive you home after the procedure
It is recommended that you take the day off work to allow yourself time to rest and relax.
Are there complications? Complications can occur but they are rare, especially if the patient adheres to all instructions provided by their doctor. Nevertheless, in rare cases, some people who have undergone the procedure have experienced severe abdominal pain, a consistent cough, chest pain, nausea, vomiting, fever and chills within 72 hours after the treatment. Thus, if any of these symptoms should occur within 72 hours, contact your doctor immediately!
Are there risks? Every medical procedure has some risk, but the ones associated with endoscopy are very rare. In the vast majority of cases, EGD is a very safe procedure when performed by an experienced physician who specializes in upper endoscopic procedure. However, rare risks associated with this procedure include:
- Reaction to medication or sedatives that are used
- Complications from pre-existing heart, lung or liver disease
- Minor bleeding may occur at biopsy site or if a polyp is removed (transfusion and/or surgery is only required if massive bleeding occurs)
- Perforation (punching a hole in an organ) – this is very rare, but the organ would generally require repair through surgery.
How much does EGD cost? Upper endoscopy generally costs anywhere from $1350.00 - $1500.00. However, price may vary depending on the location, physician, medication, and the equipment being used. Furthermore, if a patient requires additional care, the cost may be more.
Will my health insurance cover the procedure? It all depends on the type of insurance policy you have. Generally speaking, most major insurance companies such as Medicare, should cover EGD, but you will need to contact your insurance company and find out if you will be covered, and if there is a limit on your coverage. You also need to inform your insurance company that you are intending on having the EGD procedure done before going through with it.
To learn more about upper endoscopy and to find out if this procedure is right for you, talk to your doctor.
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