Esophagogastroduodenoscopy

In medicine (gastroenterology), esophagogastroduodenoscopy (EGD) or upper endoscopy is a diagnostic endoscopic procedure that visualizes the upper part of the gastrointestinal tract. It is considered a minimally invasive procedure since it does not require an incision into one of the major body cavities and does not require any significant recovery after the procedure (unless sedation or anesthesia has been used).

Indications:
In most patients an unexplained drop in hematocrit (a sign of anemia) is an indication to do an EGD, usually along with a colonoscopy. Even if no obvious blood has been seen in the sputum (spit) or stool (feces). An EGD is most important when there are signs of an upper gastrointestinal bleed (UGI bleed). UGI bleeding often presents with melena (very dark black, tarry-like stool, which often has a foul odor). Other indications include reflux disease (also called heartburn or GERD), or blood in vomitus. Chronic acid reflux can cause changes in the cells lining the esophagus, a condition called Barrett's Esophagus, which can occasionally progress to cancer if not treated. Therefore chronic reflux is also an indication for EGD.

Diagnostic use:
In its most basic use, the endoscope is used to inspect the lining of the digestive tract. Often inspection alone suffices to diagnose a patient's problem, but biopsy is a very valuable adjunct to endoscopy. Small biopsies can be made with a pincer (biopsy forceps) that is passed through the scope and allows sampling of 1 to 3 mm pieces of tissue under direct vision. The intestinal mucosa heals quickly from such biopsies.

Therapeutic use:
Additional procedures that can be done include:

• Injection of liquids through a needle (e.g. Adrenalin in bleeding lesions)
• Cutting off of larger pieces of tissue with a snare (e.g. Polyps)
• Application of cautery to tissues
• Retrieval of foreign bodies that have been ingested
• Tamponading bleeding esophageal varices with a balloon
• Some surgical procedures can be done through the endoscope including tightening of the muscles at the end of the esophagus (the lower esophageal sphincter) and rubber band ligation of esophageal and gastric blood vessels.