Upper Endoscopy (EGD)

Upper endoscopy is a procedure that allows for the direct visualization of the lining of the upper part of your gastrointestinal tract, which includes the esophagus, stomach and duodenum (first portion of the small intestine). During this procedure, a thin, flexible tube, called and endoscope, with its own lens and light source is passed through the mouth and advanced to the beginning of the small intestine.

Why is upper endoscopy done?
Upper endoscopy assists the doctor in evaluating symptoms of persistent upper abdominal pain, nausea, vomiting or difficulty swallowing. It is an excellent test for finding the cause of bleeding from the upper gastrointestinal tract and is more accurate than X-ray films for detecting inflammation, ulcers and tumors of the esophagus, stomach and duodenum.

A biopsy (small tissue sample) is often obtained during an upper endoscopy. A biopsy can distinguish between benign and malignant (cancerous) tissues, can detect the presence of Helicobacter pylori (a bacterium associated with most ulcers) and can detect Barrett’s esophagus (a potential precursor to esophageal cancer).

Upper endoscopy is also used to treat conditions of the upper gastrointestinal tract such as bleeding and to dilate strictures (narrowed areas).

How should I prepare for the procedure?
An empty stomach is essential for an accurate and safe examination, so you should have nothing to eat or drink, including water, for at least eight hours before the examination.

Can I take my current medications?
Most medications can be continued as usual. Inform us about medications you’re taking, particularly aspirin products, arthritis medications, anticoagulants (blood thinners), insulin or iron products.

What about Aspirin?
Do not stop aspirin, unless instructed by your physician or our staff.  You may have stopped aspirin before a previous upper endoscopy. The latest research and guidelines tell us that it is safe to perform routine upper endoscopy and biopsy while patients continue their aspirin. The data also shows us that the risk of bleeding is very low and when compared with the risk of a stroke or other clotting event, bleeding is relatively easy to control.  Major clotting events, such as stroke can leave irreversible damage.  When a procedure with higher bleeding risk is anticipated, such as esophageal dilation, BARRX-HALO (radiofrequency ablation) or endoscopic mucosal resection (EMR), you will usually be instructed to discontinue taking aspirin for 5 days prior to your procedure, and you may be asked to hold it for a few days after your procedure.

What about Plavix® (clopidogrel)?
Do not stop Plavix® (clopidogrel), unless instructed by your physician or our staff.  You may have stopped Plavix® (clopidogrel) before a previous upper endoscopy. The latest research and guidelines tell us that it is safe to perform routine upper endoscopy and biopsy while patients continue their Plavix® (clopidogrel).  The data also shows us that the risk of bleeding is very low and when compared with the risk of a stroke or other clotting event, bleeding is relatively easy to control.  Major clotting events, such as stroke can leave irreversible damage.  When a procedure with higher bleeding risk is anticipated, such as esophageal dilation, BARRX-HALO (radiofrequency ablation) or endoscopic mucosal resection (EMR), you will usually be instructed to discontinue taking Plavix® for 5 days prior to your procedure, and you may be asked to hold it for a few days after your procedure.

What about Pradaxa® (dabigatran)?
Please stop taking Pradaxa® (dabigatran) 36 hours before your upper endoscopy (EGD).  Pradaxa® (dabigatran) has an extremely short half-life, unlike Coumadin®, which means the blood thinning effect is gone after 24-36 hours after stopping the medication.

What about Coumadin®?
Do not stop Coumadin®.  You may have stopped Coumadin® before a previous upper endoscopy. The latest research and guidelines tell us that it is safe to perform routine upper endoscopy and biopsy while patients continue their Coumadin® as long as their INR is in the routine, therapeutic range of between 2 and 3.  The data sldo shows us that the risk of bleeding is very low and when compared with the risk of a stroke or other clotting event, bleeding is relatively easy to control.  Major clotting events, such as stroke can leave irreversible damage.  When a procedure with higher bleeding risk is anticipated, such as esophageal dilation, BARRX-HALO (radiofrequency ablation) or endoscopic mucosal resection(EMR), you will usually be instructed to discontinue taking Coumadin® for 5 days prior to your procedure, and you may be asked to hold it for a few days after your procedure.

What if I use inhalers for Asthma or other breathing problems?
Please use your inhalers as you would normally use them.  Also, please be sure and bring all of your inhalers to your procedure, as you may be asked to use them just prior to your exam.

Will I need antibiotics?
No. Even if you have a prosthetic heart valve or other prosthesis, the latest recommendations by the Gastrointestinal and Cardiovascular societies do not recommend the use of antibiotics for routine upper endoscopy regardless of prosthetic devices.

What can I expect during upper endoscopy?
Upper endoscopy is well tolerated and pain-free. You will be given a sedative, propofol, by our anesthesia team who will be present to monitor your vital signs during the examination.  You will not experience any sensation of gagging or choking. A mouthpiece will be placed between your teeth to keep your mouth open and to prevent your teeth from biting our scope. You will lie on your left side, and the endoscope will be passed through your mouth and into the esophagus, stomach and duodenum. The endoscope doesn’t interfere with your breathing. The examination typically lasts 10 minutes.

What happens after upper endoscopy?
You will be monitored until most of the effects of the medication have worn off. Your throat might be a little sore, and you might feel bloated because of air introduced into your stomach during the test. You will be given a liquid to drink before you leave our office. Once you leave the office, you will be able to eat unless you are instructed otherwise.

The results of the examination will be discussed with you. If a biopsy was taken or a polyp was removed, the material is sent to a pathology lab and the results are available in approximately 5 business days. Your results will be given to you directly at a follow-up appointment or you will receive a letter via standard mail delivery with the results and recommendations for follow-up.  All of the results, including your pathology results and procedure reports will be forwarded to your primary care physician and the physician that referred you to Gastroenterology Consultants.

You will not be allowed to drive for 12 hours. You will need to arrange for someone to accompany you home because the sedatives might affect your judgment and reflexes for the rest of the day.

What are the possible complications of upper endoscopy?
Although complications are rare, bleeding can occur at a biopsy site or where a polyp was removed. If this occurs, it’s usually minimal and rarely requires follow-up. Other potential risks include a reaction to the sedative used and a perforation (a tear in the gastrointestinal tract lining). It’s important to recognize early signs of possible complications. If you have a fever after the test, trouble swallowing or increasing throat, chest or abdominal pain, contact us immediately.