What is the purpose of an Esophagogastroduodenoscopy (EGD) study in Gastrointestinal (GI) disorders?

From the Guidelines

The primary purpose of an Esophagogastroduodenoscopy (EGD) study in Gastrointestinal (GI) disorders is to examine the upper digestive tract for conditions such as ulcers, gastritis, esophagitis, Barrett's esophagus, or upper GI tumors, and to provide direct visualization of the GI mucosa for immediate diagnosis and therapeutic intervention. This procedure is recommended for patients experiencing persistent upper abdominal pain, difficulty swallowing, unexplained weight loss, persistent heartburn, vomiting blood, or when there's suspicion of conditions like ulcers, gastritis, esophagitis, Barrett's esophagus, or upper GI tumors 1. The indications for EGD include:

• Typical GERD symptoms that persist despite a therapeutic trial of 4 to 8 weeks of twice-daily proton-pump inhibitor therapy
• Severe erosive esophagitis after a 2-month course of proton-pump inhibitor therapy to assess healing and rule out Barrett esophagus
• History of esophageal stricture who have recurrent symptoms of dysphagia
• Men older than 50 years with chronic GERD symptoms and additional risk factors to detect esophageal adenocarcinoma and Barrett esophagus 1. Before an EGD, patients typically fast for 6-8 hours, stop blood thinners as directed by their physician, and arrange for someone to drive them home afterward. During the procedure, which takes about 15-30 minutes, patients receive sedation while a flexible tube with a camera is passed through the mouth to visualize the upper GI tract. The gastroenterologist can take biopsies or perform therapeutic interventions like removing polyps or dilating strictures. After the procedure, patients may experience mild throat soreness or bloating, but can usually resume normal activities the next day. EGD is valuable because it provides direct visualization of the GI mucosa, allowing for immediate diagnosis of many conditions and therapeutic intervention in the same session, which is not possible with imaging studies like X-rays or CT scans 1. It is essential to note that unnecessary endoscopy exposes patients to preventable harms, may lead to additional unnecessary interventions, and results in unnecessary costs, highlighting the importance of adhering to established guidelines for the appropriate use of EGD 1.

From the Research

Purpose of Esophagogastroduodenoscopy (EGD) in Gastrointestinal (GI) Disorders

The purpose of an EGD study in GI disorders is to:

• Diagnose and manage upper GI bleeding, which is defined as bleeding proximal to the ligament of Treitz 2, 3
• Identify the cause of upper GI bleeding, such as peptic ulcer disease, esophagitis, variceal bleeding, and Mallory-Weiss syndrome 2, 3
• Allow for therapeutic interventions, such as endoscopic hemostasis, to be performed during the procedure 3
• Evaluate the effectiveness of treatments, such as proton pump inhibitors, in reducing the risk of rebleeding and improving outcomes in patients with upper GI bleeding 4, 5

Common Indications for EGD

Common indications for EGD include:

• Upper GI bleeding, characterized by hematemesis, melena, or fresh bleeding per rectum 2, 3
• Abdominal pain, lightheadedness, dizziness, syncope, and other symptoms suggestive of upper GI bleeding 2
• Prior upper GI bleeding, anticoagulant use, high-dose nonsteroidal anti-inflammatory drug use, and older age, which are risk factors for upper GI bleeding 2
• Dysphagia and poor nutrition, which may require the placement of a percutaneous endoscopic gastrostomy (PEG) tube 6

Diagnostic and Therapeutic Capabilities of EGD

EGD has several diagnostic and therapeutic capabilities, including:

• Visualization of the upper GI tract to identify the source of bleeding 3
• Performance of endoscopic hemostasis to control bleeding 3
• Administration of medications, such as proton pump inhibitors, to reduce acid production and promote healing 4, 5
• Placement of PEG tubes for nutritional support in patients with dysphagia and poor nutrition 6