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upper gastrointestinal (GI) endoscopy; esophagogastroduodenoscopy (EGD)

Indications: - dysphagia - esophageal disease - esophageal dysmotility - esophageal obstruction - esophageal stricture - achalasia - Barrett esophagus - tracheoesophageal fistula - GERD - upper gastrointestinal bleeding due to hepatic cirrhosis - esophageal varices - gastric varices - peptic ulcer disease - gastric disease - gastritis - achlorhydria - gastroparesis - gastric outlet obstruction - intestinal obstruction - ileus - intestinal perforation - gastrointestinal neoplasm - esophageal cancer - gastric cancer - intestinal neoplasm Procedure: - a flexible fiberoptic scope is advanced through the mouth into the upper gastrointestinal tract - this allows for direct visualization of the gastrointestinal mucosa & provides an opportunity for tissue sampling for diagnosis - the esophagus may also be dilated during the procedure - sites of upper gastrointestinal bleeding may be ligated, cauterized or photocoagulated - push enteroscopy advances the endoscope into the jejunum [1] Complications: - procedure-re Management: - can be safely performed in patients with INR < 3.0 [1] - sedation with intravenous benzodiazepine & opioid combination is standard - proton pump inhibitor prior to endoscopy may improve accuracy of screening for Barrett's esophagitis [2] - repeat EGD may detect source of obscure bleed [1] - patients should remain in hospital for 72 hours after endoscopy for high-risk peptic ulcer (stage 1A-2B) [1] - treat low-risk ulcers with oral proton pump inhibitor, resume food, hospital discharge within 12-24 hours - biopsy or resection of gastric polyps [4] - resection is indicated for all adenomatous polyps, hyperplastic polyps >= 0.5 cm, & fundic gland polyps >= 1 cm - gastric sampling or resection is indicated in patients with familial adenomatous polyposis [4] - biopsy of surrounding mucosa in the setting of multiple adenomatous or hyperplastic polyps [4] - surveillance endoscopy 1 year after resection of adenomatous polyps [4] - consider surveillance endoscopy in patients with intestinal metaplasia with risk factors (surveillance interval unclear) - surveillance endoscopy within 6 months of the diagnosis of pernicious anemia [4] - endoscopic resection & surveillance of intestinal metaplasia with high-grade dysplasia [4]

Specific

cholecystoenterostomy with gastroenterostomy double-balloon enteroscopy (push & pull enteroscopy) duodenoscopy endoscopic small bowel biopsy esophagoscopy; esophageal endoscopy ileoscopy via ileostomy push enteroscopy Sonde enteroscopy upper gastrointestinal endoscopic ultrasound-guided FNA upper gastrointestinal endoscopic with transmural drainage of pseudocyst upper gastrointestinal endoscopy for GERD upper gastrointestinal endoscopy with ablation of neoplasm/polyp upper gastrointestinal endoscopy with dilation of gastric outlet obstruction upper gastrointestinal endoscopy with dilation of stricture upper gastrointestinal endoscopy with foreign body removal upper gastrointestinal endoscopy with ligation of esophageal/gastric varices upper gastrointestinal endoscopy with percutaneous placement of gastrostomy tube upper gastrointestinal endoscopy with sclerotherapy for esophageal/gastric varices upper gastrointestinal endoscopy with stent placement upper gastrointestinal endoscopy with suturing of esophagogastric junction video capsule endoscopy (PillCam)

General

gastrointestinal endoscopy

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 11, 15, 16, 17. American College of Physicians, Philadelphia 1998, 2009, 2012, 2015 - Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
  2. Hanna S et al, Detection of Barrett's esophagus after endoscopic healing of erosive esophagitis. Am J Gastroenterol 2006, 101:1416 PMID: 16863541
  3. Hirota WK, Zuckerman MJ, Adler DG et al ASGE guideline: the role of endoscopy in the surveillance of premalignant conditions of the upper GI tract. Gastrointest Endosc. 2006 Apr;63(4):570-80. PMID: 16564854
  4. ASGE Standards of Practice Committee et al. The role of endoscopy in the management of premalignant and malignant conditions of the stomach. Gastrointest Endosc 2015 Apr 30 PMID: 25935705 http://www.giejournal.org/article/S0016-5107%2815%2902277-4/abstract
  5. Leighton JA The role of endoscopic imaging of the small bowel in clinical practice. Am J Gastroenterol. 2011 Jan;106(1):27-36 PMID: 20978483
  6. Upper GI Endoscopy https://www.niddk.nih.gov/health-information/diagnostic-tests/upper-gi-endoscopy