Upper Endoscopy (EGD) & Procedure Instructions
Upper endoscopy (EGD) is the examination of the upper gastrointestinal tract using a long, flexible scope. This procedure allows your physician to observe all parts of the upper gastrointestinal tract – the esophagus, the stomach, and the first part of your small intestine. Upper endoscopy (EGD) can be used to investigate symptoms, diagnose or biopsy for diseases, or treat digestive system problems. It is sometimes ordered to test for anemia, bleeding, inflammation, diarrhea or cancers of the digestive system. Patients experience little or no discomfort during the procedure and it typically takes 30 minutes or less.
Upper endoscopy (EGD) is the examination of the upper gastrointestinal tract using a long, flexible scope. The procedure allows your physician to observe all parts of the upper gastrointestinal tract. The instrument used is an upper endoscope. It is a long, thin, flexible tube about twice the diameter of a pencil. There are approximately four channels within the “scope” through which the physician may illuminate, wash, suction, photograph and biopsy the upper gastrointestinal tract. These channels provide the make it possible to biopsy abnormal tissue, remove polyps, cauterize blood vessels to stop active bleeding, or to prevent re-bleeding. In addition, sclerosing agents can be injected into varices, (dilated vessels seen in the upper portion of the stomach or esophagus in patients with cirrhosis of the liver), or these varices can be banded with small rubber bands. Strictures (narrowed areas in the upper GI tract secondary to scarring from reflux or ulcer disease), can be dilated utilizing several different types of dilators.
You have been scheduled for an upper endoscopy (examination of the esophagus, stomach, and duodenum). You will receive sedatives to make the procedure more comfortable. If you are undergoing a colonoscopy (examination of your large intestine) on the same day as your upper endoscopy, click here for what to expect for the colonoscopy portion of your procedure.
It is important that you arrive at the designated time so there is ample time to prepare you for your procedure.
Please adhere to the following guidelines:
- Please bring your insurance card with you.
- Leave all valuables at home except your glasses and hearing aids. You or your ride will be responsible for making sure you have them with you upon leaving the unit.
- Wear casual/comfortable clothing.
- Bring a small amount of cash (or checkbook) to pay for any copay you may have, or prescription needed after your procedure.
- It is perfectly appropriate for you to brush your teeth on the day of your procedure. (We encourage you to do so). Please wear your dentures; if we need them removed, we will provide a denture cup for you to store them safely.
Please notify our scheduler if you have special needs or preferences.
- If you choose to provide us with a copy of your advance directive, we will keep a copy in your chart. However, we will make every effort to resuscitate you in the event of an emergent situation. If you wish to receive additional information regarding this policy, you may contact the facility directly.
- If your procedure is scheduled at Oregon Endoscopy Center, for your safety if your weight exceeds 350 pounds, or your BMI is ≥ 50, please notify one of our schedulers right away.
You must follow the procedure preparation instructions carefully to minimize the risk of aspirating stomach contents into your lungs.
Upon arrival, you will be checked in by facility front desk staff. Once checked in, you will remain in the facility waiting room until called to the admission area. In the admission area, you will be shown to a bed in a private bay and will change into a procedural gown. A nurse will listen to your heart and lungs and place an intravenous line in your hand or arm, which is how you will receive medication during the procedure.
- If you received a phone call before the day of your procedure and have already answered questions about your health history and medications/allergies, a nurse will ask for any updates.
- If you did not get a phone call, you will be asked questions about your health history, medication use, and medication allergies.We must have a complete list of your medications.
Upper endoscopy is performed in a specially equipped private room. Once you have spoken with your doctor, you will be asked to sign your informed consent. A nasal cannula will be placed in your nose that will deliver supplemental oxygen, and you will be connected to the vitals monitor (your pulse, blood pressure, and oxygen level will be monitored continuously throughout the procedure). You will be asked if you have anything loose or removable in your mouth, and a bite block will be placed in your mouth, which protects your teeth and the endoscope. You will be asked to turn on your left side, and the head of the bed will be elevated. Your nurse or Certified Registered Nurse Anesthetist (CRNA) will make every effort to ensure you are as comfortable and relaxed as possible by administering sedation medications through your intravenous line. The doctor will insert the endoscope into your mouth and down your esophagus (throat).
During the procedure, it is necessary to inflate the stomach with air and carbon dioxide (CO2) to smooth out the normally wrinkled walls of the stomach and small bowel. This combination of air and CO2 will ease the insertion of the scope and improve the view of the stomach and small bowel.
Once the doctor has finished the exam, the upper endoscope will be removed. The entire examination takes 10 and 30 minutes. You will be taken to the recovery area for monitoring after the procedure. Due to the nature of the medications used during the procedure, it is common to remember little or nothing of the procedure or parts of your recovery. You may experience some abdominal discomfort due to air in your stomach or small bowel; this can last 20 to 30 minutes, but this is normally minimal.
After the procedure, a nurse will speak to you about your exam findings and provide you with a detailed report, including pictures, prepared by your doctor. You will need to refer to the report sent home for questions and post-procedure instructions, as you will likely not remember information given to you immediately following the procedure. Important numbers will be bold or in red on your report. If you need any follow-up procedures, office visits, or medical tests, someone from Eugene Gastroenterology Consultants will contact you to arrange these for you.
Due to the nature of the medications used during the procedure, you MUST have someone transport you home after your procedure. Once you’ve returned home, do not operate any machinery, sign any important legal paperwork, or drive a motor vehicle for at least 24 hours since minor effects of the drugs may persist the rest of the day.
* For female-identifying patients, you will have a female endoscopy technician, nurse, or Certified Registered Nurse Anesthetist (CRNA) in the procedure room with you for the entire procedure.
What can I expect for sedation with my procedure?
Oregon Endoscopy Center (OEC) offers two different types of procedural sedation for endoscopic procedures: moderate sedation (also referred to as conscious sedation) and deep sedation. Both are safe for most patients, and your vital signs and breathing are monitored throughout the procedure during both types of sedation. Please note that these types of sedation are NOT general anesthesia that you would expect during surgery but are known as procedural sedation. Your doctor will determine which of these types of sedation is right for you when you are scheduled for your procedure, and it will also be run through your insurance to see which one is covered on your plan. Both modes of sedation aim to keep you comfortable enough to tolerate the procedure and to lie still enough so your doctor can examine your colon or upper GI tract organs (esophagus, stomach, and small bowel) thoroughly and safely. The vast majority of patients prefer deep sedation over moderate sedation due to a much faster recovery from the sedating effects of the sedatives.
Moderate Sedation
If you are scheduled for moderate sedation, you will have medications administered through your IV by a sedation-qualified registered nurse (RN) whose main role is to ensure you are comfortable and safe during the procedure. They will monitor your vital signs and breathing throughout the procedure. All RNs and physicians at Oregon Endoscopy Center are certified in Basic Life Support (BLS) and Advanced Cardiovascular Life Support (ACLS).
Moderate Sedation Medications. RNs use a combination of medications that help you relax and decrease pain so you are comfortable during the procedure. The two most common medications used are fentanyl and midazolam, but other similar medications can be used if you have an allergy to these medications. The RN will give you small doses of medication at a time before the start of the procedure to make you drift off to sleep. The RN will administer more medication if you become uncomfortable during the procedure. Near the end of the procedure, they will allow you to wake up naturally. During the procedure, you should be able to open your eyes and respond if your nurse talks to you, and you should be able to follow their directions, i.e., rollover or take a deep breath. However, because of how these medications work, you will most likely not remember being briefly awakened during the procedure.
Breathing and Monitoring. As the medications start to work, they will make you sleepy, and your heart rate, breathing, and blood pressure may slow down or decrease. You will have an oxygen tube in your nose to keep your oxygen levels normal. Your vital signs, including blood pressure, heart rate, breathing rate, and oxygen levels, will be monitored continuously by the RN throughout the procedure.
Recovery. After the procedure, you will be brought back to the recovery area and monitored for another 20-30 minutes by the nursing staff. You will start to wake up near the end of the procedure and then even more in recovery. Conscious sedation medications wear off quickly, but everyone is different; some people are affected longer than others. You may feel sleepy, lethargic, woozy, foggy, forgetful, dizzy, light-headed, or “out of it” for many hours after this type of sedation. It is important to have a responsible driver to drive you home after the procedure and remain with you for a few hours, if possible. You should not drive, operate machinery, climb ladders, do any strenuous activities, drink alcohol, or use marijuana products after receiving conscious sedation. You may drive and return to normal activities the day after your procedure.
Deep Sedation
If you are scheduled for deep sedation, you will have medications administered through your IV by a certified registered nurse anesthetist (CRNA) whose main role is to ensure you are comfortable and safe during the procedure. They will monitor your vital signs and breathing throughout the procedure. All CRNAs are certified in Basic Life Support (BLS) and Advanced Cardiovascular Life Support (ACLS).
CRNAs are registered nurses who have received higher education focusing on anesthesia. They are not medical doctors.
Deep sedation. CRNAs mainly use a medication called propofol that will allow you to sleep during the procedure. Occasionally, the CRNA may give other medications, such as a strong narcotic, sedative, or medication to decrease pain at the IV site, in addition to propofol. It is not the norm in most cases, but it may be necessary in some cases to make sure you are comfortable. The CRNA will administer a dose of propofol to get you to sleep quickly to achieve deep sedation, then give you more throughout the procedure to keep you asleep. Near the end of the procedure, they will stop giving you the propofol, so you wake up naturally. You will be unaware of the procedure or discomfort while under deep sedation.
Breathing and Monitoring. Deep sedation will make your heart rate, breathing, and blood pressure slow down or decrease, but typically only a small and inconsequential amount. However, you will be breathing on your own, as breathing tubes/machines are unnecessary, and you will have oxygen tubing in your nose to assist with oxygen levels. Your vital signs, including blood pressure, heart rate, breathing rate, and oxygenation status, will be monitored continuously by the CRNA throughout the procedure.
Recovery. After the procedure, you will be brought back to the recovery area and monitored for another 20-30 minutes by the nursing staff. You will start to wake up near the end of the procedure and even more in recovery. Propofol wears off quickly, but everyone is different; some people are affected longer than others. Propofol is known to have people feeling back to normal much quicker, unlike other types of sedation, but it is still quite individualized. You may feel sleepy, lethargic, woozy, foggy, forgetful, dizzy, light-headed, or “out of it” for many hours after this type of sedation. However, all patients do not experience these effects after propofol. It is important to have a responsible driver to drive you home after the procedure and remain with you for a few hours, if possible. You should not drive, operate machinery, climb ladders, do any strenuous activities, drink alcohol, or use marijuana products after receiving propofol sedation. You may go back to normal activities the day after your procedure.
Forgetfulness is normal immediately after the procedure and is due to the use of a sedative during the endoscopy (EGD). Due to the nature of the medications used during the procedure, you must have someone drive you home after your procedure. Once you have returned home, do not operate machinery and do not to drive for at least 24 hours, as the effects of the drugs may persist.
Gas
Abdominal gas or bloating caused by the introduction of air into the stomach may cause some discomfort for a short time after the procedure. Belching or passing gas will help to relieve this symptom. Refrain from eating large amounts of food until you have returned to your normal state of comfort.
Nausea
Uncommonly, nausea my result from the abdominal gas and/or the medications used during the procedure. It is recommended that you remain on clear fluids until the nausea subsides. Should vomiting occur for an extended period (more than 6 hours), notify your physician. Bedrest is recommended.
Sore throat
Occasionally, a sore throat may be present following the procedure due to the passage of the scope through the oropharynx into the esophagus. If this occurs, it is generally mild and lasts up to 2 days. Once your swallowing reflex has returned, you will find warm drinks very soothing. You may also take Tylenol for minor discomfort but inform your physician if the symptoms worsen. Topical therapy with throat lozenges or sprays usually help to relieve this symptom; gargling with saltwater may help to decrease inflammation. If a severe sore throat is present or this symptom persists longer than 3 days, call your physician.
Notify Your Physician If You Experience Any Worrisome Symptoms
- Fever, severe pain or excessive bleeding should be reported to your doctor immediately.
- Localized irritation of the vein (phlebitis) at the I.V. site may occur at the site of medication injection. A tender lump develops which may remain for several weeks to several months, but it goes away eventually. Elevation of the arm and warm set compresses applied to the site several times per day should help. If a red streak should form that appears to follow the route of a vein and extends up your arm, notify your doctor immediately.
- Should you have any questions after your procedure, please call our office and your call will be directed to your physician’s triage nurse. Phone: 541-868-9500 or Toll-Free: 877-484-4501
Your Test Results
A pathology report of any biopsied tissue should be received by our office in 14 days. If you have not heard from us after 14 days, please call our office and your call will be directed to your physician’s triage nurse.
It is your right to be thoroughly informed of the risks and possible complications before deciding to undergo a recommended upper endoscopy (EGD) procedure.
Although any medical test has some risk associated with it, serious problems associated with upper endoscopy (EGD) are very uncommon. When they occur, they are very treatable. Because of its acceptability, low risk, accuracy, and the variety of tasks it can accomplish, upper endoscopy (EGD) is well recognized as an important test in appropriate situations.
There is a 1 in 100 chance of some complications when upper endoscopy (EGD) is used to diagnose issues, but most minor; serious problems are uncommon.
There is a risk of bleeding in about 1 of 3,000 procedures. Any persistent bleeding that is manifested by vomiting blood or passing black bowel movements should be reported to your physician.
There is a risk of perforating the upper gastrointestinal tract with the scope in about 1 of 4,000 procedures.
There is a risk of temporary irregularity of the heart. For this reason, if you have a history of heart disease, your heart may be monitored with an electrocardiogram to minimize risk to you.
There is a risk of an allergic or other reaction to the drugs administered during the procedure.
These are rare, and the effects of the drugs can be reversed with other drugs.
There is a risk of aspiration (vomiting stomach contents and going into the lungs). This is rare, and the stomach should be empty at the time of the procedure.
There is a slightly higher risk of complications if dilation or sclerotherapy is performed during your procedure.
Death is extremely rare but remains a possibility.
The most common alternative to upper endoscopy (EGD) is an upper GI X-ray examination utilizing barium. This examination requires that you swallow barium (a chalky liquid), and X-rays are taken. Some abnormalities of the upper gastrointestinal tract can be detected by studying these films; however, the procedure is generally recognized as not being as accurate as an upper endoscopy (EGD) and does not allow for biopsy and removal of tissue.
Other procedures that may be done prior to upper endoscopy (EGD) (but are not considered alternatives to the procedure) are CAT scan, ultrasound, and nuclear medicine scans. These studies are utilized to assess other structures but may complement the findings of endoscopy (EGD).
Note: The information in this section is provided as a supplement to information discussed with your healthcare provider. It is not intended to serve as a complete description of a particular topic or substitute for a clinic visit.
