Esophagogastroduodenoscopy Technique

Updated: Feb 22, 2017
  • Author: Tony E Yusuf, MD; Chief Editor: Praveen K Roy, MD, AGAF  more...
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Technique

Upper Gastrointestinal Endoscopy

Antibiotic prophylaxis

Transient bacteremia may occur during most endoscopic procedures, but the risk of infectious complications (including endocarditis) is low.

Antibiotic prophylaxis is clearly recommended when patients with an underlying high-risk condition for infectious complications (eg, a prosthetic heart valve or a history of endocarditis) undergo a high-risk endoscopic procedure (eg, stricture dilation, sclerotherapy of varices, or endoscopic retrograde cholangiopancreatography [ERCP]) in the presence of an obstructed biliary tree. All patients undergoing percutaneous endoscopic gastrostomy (PEG) placement should receive antibiotic prophylaxis against soft-tissue infections; the regimen usually includes cefazolin 1 g intravenously (IV).

The patient's condition and the nature of the procedure should be reviewed carefully, and the decision to administer antibiotic prophylaxis should be individualized. An acceptable prophylaxis regimen is parenteral ampicillin at 2 g and gentamicin at 1.5 mg/kg (up to 80 mg) 30 minutes prior to the procedure. Vancomycin 1 g IV is substituted for penicillin in patients who are allergic to penicillin.

Specific recommendations for antibiotic prophylaxis based on the type of the endoscopic procedure that is being contemplated and the underlying patient condition are available from the American Society for Gastrointestinal Endoscopy (ASGE). [25]

Procedure

The patient is usually placed in the left lateral position. Administer topical and/or IV sedation to minimize gagging and to facilitate the procedure. An antispasmodic agent (eg, hyoscine butylbromide, atropine, glucagon, cimetropium bromide, or phloroglucin [26] ) may be given to suppress gastrointestinal (GI) peristalsis. Place a bite block to prevent damage to the endoscope and to ease its passage through the mouth.

Under direct vision, pass the endoscope through the pharynx, esophagus, and stomach and into the duodenum, with careful inspection upon both insertion and slow withdrawal. Insufflate air to distend the lumen so as to facilitate viewing. Liquid and particulate matter can be aspirated through the suction channel. (See the videos below.)

Esophagastroduodenoscopy. Video courtesy of George Y Wu, MD, PhD.
This video shows the insertion of the endoscope over the mouth, into the oropharynx. The vocal cords, epiglottis, and piriformis sinuses are seen, and the scope is advanced into the right piriformis sinus and behind the epiglottis and into the esophagus. This is a normal esophageal intubation when performing esophagogastroduodenoscopy. Video courtesy of Dawn Sears, MD, and Dan C. Cohen, MD, Division of Gastroenterology, Scott & White Healthcare.

The procedure and findings can be documented with pictures or a video system. Biopsy specimens can be obtained by passing a forceps and taking small mucosal samples for histology studies. (See the videos below.)

This video, captured via esophagogastroduodenoscopy, shows biopsy samples being obtained from the duodenum. The duodenal folds show some "scalloping," and biopsies are obtained to rule out celiac sprue. Video courtesy of Dawn Sears, MD, and Dan C. Cohen, MD, Division of Gastroenterology, Scott & White Healthcare.
This video, captured via esophagogastroduodenoscopy (EGD), depicts the obtaining of biopsies of the duodenum. This is often performed during EGD to rule out certain diseases. Video courtesy of Dawn Sears, MD, and Dan C. Cohen, MD, Division of Gastroenterology, Scott & White Healthcare.
This video, captured via esophagogastroduodenoscopy, shows an abnormal polyp within the stomach. It is then biopsied in order to obtain a pathologic diagnosis and to rule out malignancy. Video courtesy of Dawn Sears, MD, and Dan C. Cohen, MD, Division of Gastroenterology, Scott & White Healthcare.
This video, captured via esophagogastroduodenoscopy, shows erythema of antrum of the stomach consistent with gastritis. Biopsies are obtained to rule out Helicobacter pylori infection. Video courtesy of Dawn Sears, MD, and Dan C. Cohen, MD, Division of Gastroenterology, Scott & White Healthcare.

Numerous therapeutic procedures can be performed during the endoscopy (see the videos below). The procedure may last from 5 to 30 minutes or longer, depending on which diagnostic or therapeutic maneuvers are used.

This video, captured via esophagogastroduodenoscopy, shows the treatment of a bleeding duodenal ulcer by deployment of an Endoclip. Video courtesy of Dawn Sears, MD, and Dan C. Cohen, MD, Division of Gastroenterology, Scott & White Healthcare.
This video, captured via esophagogastroduodenoscopy, shows dilation of a duodenal stricture. In this case, the patient developed an NSAIDS-related stricture. He underwent balloon dilation to relieve symptoms of nausea, vomiting, weight loss, and early satiety. The stricture had been biopsied previously to rule out malignancy. Video courtesy of Dawn Sears, MD, and Dan C. Cohen, MD, Division of Gastroenterology, Scott & White Healthcare.
This video, captured via esophagogastroduodenoscopy, depicts treatment of an arteriovenous malformation (AVM) in the small intestine using argon plasma coagulation (APC). AVMs are a common cause of gastrointestinal bleeding. Video courtesy of Dawn Sears, MD, and Dan C. Cohen, MD, Division of Gastroenterology, Scott & White Healthcare.
This video, captured via esophagogastroduodenoscopy, shows the treatment of a duodenal ulcer with injection of epinephrine into the ulcer. The mucosa is friable and bleeds easily when manipulated. Video courtesy of Dawn Sears, MD, and Dan C. Cohen, MD, Division of Gastroenterology, Scott & White Healthcare.
This video, captured via esophagogastroduodenoscopy, shows the use of the HALO 90 device in order to perform radiofrequency ablation in a patient with Barrett esophagus. Barrett esophagus increases the risk of developing esophageal cancer. Video courtesy of Dawn Sears, MD, and Dan C. Cohen, MD, Division of Gastroenterology, Scott & White Healthcare.

The videos below depict normal EGD findings.

This video shows a normal esophagus via esophagogastroduodenoscopy. Video courtesy of Dawn Sears, MD, and Dan C. Cohen, MD, Division of Gastroenterology, Scott & White Healthcare.
This video, captured with esophagogastroduodenoscopy, shows a normal Z line, which is another name for the esophageal gastric (EG) junction. Video courtesy of Dawn Sears, MD, and Dan C. Cohen, MD, Division of Gastroenterology, Scott & White Healthcare.

The videos below depict various abnormal EGD findings.

This video, captured via esophagogastroduodenoscopy, shows classic "scalloping" of the duodenal folds, a finding seen in celiac sprue. Video courtesy of Dawn Sears, MD, and Dan C. Cohen, MD, Division of Gastroenterology, Scott & White Healthcare.
This video, captured via esophagogastroduodenoscopy, depicts erosive gastritis. The antrum of the stomach is erythematous, and some erosions are noted, but no obvious ulcers. Video courtesy of Dawn Sears, MD, and Dan C. Cohen, MD, Division of Gastroenterology, Scott & White Healthcare.
This video, captured via esophagogastroduodenoscopy, shows erosive duodenitis, shallow mucosal erosions within the bulb of the duodenum. This can be caused by NSAIDS or Helicobacter pylori infection, in addition to other etiologies. Video courtesy of Dawn Sears, MD, and Dan C. Cohen, MD, Division of Gastroenterology, Scott & White Healthcare.
This video, captured via esophagogastroduodenoscopy, shows portal hypertensive gastropathy (PHG). These are changes to the stomach mucosa caused by advanced liver disease. The mucosa has a "snake skin" appearance. Video courtesy of Dawn Sears, MD, and Dan C. Cohen, MD, Division of Gastroenterology, Scott & White Healthcare.
This video, captured via esophagogastroduodenoscopy, shows a moderate to severe case of portal hypertensive gastropathy (PHG). These are changes to the stomach mucosa caused by advanced liver disease. The mucosa has a "snake skin" appearance. Video courtesy of Dawn Sears, MD, and Dan C. Cohen, MD, Division of Gastroenterology, Scott & White Healthcare.
This video shows "trachealization" of the esophagus, the finding of rings similar to those in the trachea. This is commonly seen in eosinophilic esophagitis. Video courtesy of Dawn Sears, MD, and Dan C. Cohen, MD, Division of Gastroenterology, Scott & White Healthcare.
This video shows inflammation and erosion at the distal esophagus, erosive esophagitis. The bleeding is likely secondary to a biopsy that had been performed. Video courtesy of Dawn Sears, MD, and Dan C. Cohen, MD, Division of Gastroenterology, Scott & White Healthcare.
This video shows severe distal reflux esophagitis via esophagogastroduodenoscopy. Video courtesy of Dawn Sears, MD, and Dan C. Cohen, MD, Division of Gastroenterology, Scott & White Healthcare.
This video, captured with esophagogastroduodenoscopy, shows an esophageal varix with a nipple, which is a sign of recent bleeding. Video courtesy of Dawn Sears, MD, and Dan C. Cohen, MD, Division of Gastroenterology, Scott & White Healthcare.
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Complications

The major complications of EGD are as follows:

  • Bleeding
  • Infection
  • Perforation [27]
  • Cardiopulmonary problems

Cardiopulmonary events make up 50% of all major complications; such events are usually caused by the medications used for conscious sedation. [28]  Approximately one complication occurs for every 1000 EGD procedures. The mortality is approximately 0.5-3 deaths for every 10,000 procedures.

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