Upper endoscopy (also referred to as an EGD, esophagogastroduodenoscopy, upper gastrointestinal endoscopy, upper GI endoscopy, gastroscopy, esophagoscopy, or just endoscopy) is a procedure that allows the physician to diagnose and treat problems in the upper gastrointestinal (UGI) tract. It is often used when diagnosing eosinophilic esophagitis (EoE), GERD and other gastrointestinal disorders. This document is specific to patients seeking diagnosis or treatment for EoE symptoms.
To perform the procedure, the physician uses a long, flexible, lighted tube called an endoscope. The endoscope is guided through the patient's mouth and throat, then through the esophagus, stomach, and duodenum (first part of the small intestine). The physician can examine the inside of these organs and detect abnormalities.
In addition to performing visual examination of the UGI tract with the endoscope, the doctor can insert instruments through the endoscope to get tissue samples for a biopsy, remove foreign objects, instill air or fluid, stop bleeding or perform therapeutic procedures, such as endoscopic surgery, laser therapy or dilatation (opening up). A video camera in the endoscope provides images onto a TV-like monitor.
An upper endoscopy may be performed to diagnose structural or functional problems of the esophagus, stomach, and/or duodenum. These may include, but are not limited to, the following:
- Dysphagia (difficulty swallowing)
- Weight loss or anorexia (loss of appetite)
- Upper abdominal pain or chest pain of a noncardiac origin
- Gastroesophageal reflux disease (GERD)
- Intractable vomiting (continuous vomiting from an unknown cause)
- Removing obstructions like food or coins in the esophagus
- Damage caused by ingestion of caustic substances (chemicals such as lye, household detergents)
- Suspected eosinophilic esophagitis or reassessment of the esophagus after food elimination or reintroduction
The child's physician or nurse practitioner will explain the procedure during a clinic visit. This is a great time to ask questions; there are no questions that are too basic or silly to ask. During this visit, the child’s parent or legal guardian will be asked to sign a consent form that gives permission to do the test. It is important for caregivers to read the form carefully and ask questions if something is not clear.
Caregivers should notify the physician if the child is sensitive to or is allergic to any medications, latex, tape or anesthetic agents (local and general). The physician should also be told if the child has a history of bleeding problems or is taking any medications, including prescribed and over-the-counter medicines, as well as vitamins and herbal supplements. Learn more about how to prepare children of all ages for surgery.
Depending upon the child’s age, restrictions are placed on when the child can eat or drink prior to surgery. These guidelines are referred to as “NPO guidelines” and not following these guidelines as discussed may result in the procedure being delayed or rescheduled for another day. Learn more about the CHOC Children’s NPO guidelines.
When it is time for the actual procedure, the child is taken to the endoscopy suite. Family members are unable to be with the child during this time. However, he or she will be carefully monitored by a board-certified anesthesiologist throughout the procedure using what is called “monitored anesthesia.” The child will breathe on their own, but will be in a deep sleep. The child’s blood pressure, heart rate, breathing rate, skin color and oxygen levels are constantly observed. The procedure itself takes about ten minutes.
After the visual inspection of the esophagus, stomach and small bowel has been completed, the physician will take freckle-sized pieces of tissue from the lining of the small intestine, bowel, stomach and esophagus. These tissue samples are called biopsies. The staff in the endoscopy suite will prepare the pieces of tissue for examination under a microscope. This exam is done by a special physician called a pathologist. This is a very important part of the test as it will provide important information about the child’s condition.
After the procedure, parents or legal guardians have an opportunity to speak with the physician to get their immediate feedback about the procedure and view some pictures taken during the upper endoscopy.
Notify the physician if the child experiences any of the following after returning home:
- Fever and/or chills
- Redness, swelling, bleeding or other drainage from the IV site
- Abdominal pain, nausea, and/or vomiting
- Black, tarry, or bloody stools
- Swallowing difficulties
- Throat or chest pain that worsens or does not get better after 48 hours.
The child’s physician may provide additional or alternate instructions after the procedure, depending on the child’s particular situation.
As with any invasive procedure, complications can occur. Some possible complications may include, but are not limited to, the following:
- Perforation (a tear in the lining) of the duodenum, esophagus, or stomach