What is an EGD (Esophagogastroduodenoscopy)?

What is an EGD (Esophagogastroduodenoscopy)?

An EGD is an endoscopic procedure that examines the upper gastrointestinal tract, including the esophagus, stomach, and duodenum, used for diagnosis and management of various upper GI conditions. 1

Definition and Scope

• EGD (Esophagogastroduodenoscopy) is a common endoscopic procedure that visualizes and evaluates the upper gastrointestinal tract, including the esophagus, stomach, and duodenum 1
• The procedure involves inserting a flexible tube with a camera (endoscope) through the mouth to directly visualize the mucosal lining of these organs 1
• EGD allows for both diagnostic evaluation and therapeutic interventions in a single session 1

Technical Aspects of the Procedure

• A high-definition video endoscopy system should be used to ensure optimal visualization of the mucosa 1
• The procedure begins at the upper esophageal sphincter and should reach the second part of the duodenum to ensure complete examination 1
• Standard examination includes visualization of key anatomical landmarks: upper esophagus, gastroesophageal junction, fundus, gastric body, incisura, antrum, duodenal bulb, and distal duodenum 1
• The gastric fundus should be inspected using a J-maneuver in all patients 1
• A complete EGD typically takes approximately 7 minutes, with evidence showing that examinations lasting longer than 7 minutes have a three-fold increase in detection of gastric cancer and dysplasia 1

Quality Standards

• Photo-documentation of relevant anatomical landmarks and any detected lesions should be performed during the procedure 1
• Adequate mucosal visualization should be achieved through proper air insufflation, aspiration, and mucosal cleansing techniques 1
• Image enhancement technologies should be used to improve detection of preneoplasia and neoplasia 1
• Endoscopists should spend sufficient time carefully inspecting the foregut mucosa in both anterograde and retroflexed views 1
• To maintain proficiency, endoscopists should aim to perform a minimum of 100 EGDs annually 1

Clinical Applications

• EGD is indicated for diagnosis and management of upper GI symptoms and conditions including dyspepsia, dysphagia, gastroesophageal reflux disease, and upper GI bleeding 2
• The procedure is recommended for patients with alarm symptoms such as dysphagia, bleeding, anemia, weight loss, and recurrent vomiting due to risk of underlying malignancy 2
• EGD allows for biopsy collection using standardized protocols for conditions such as Barrett's esophagus, eosinophilic esophagitis, and suspected malignancies 1
• Therapeutic interventions can be performed during EGD, including treatment of bleeding lesions, removal of foreign bodies, and dilation of strictures 3

Safety Considerations

• EGD is generally a safe procedure with a low complication rate 4
• The risk of perforation associated with EGD is approximately 0.033% (1 in 3,000 procedures) 4
• Sedation practices should follow established guidelines, with consideration of patient age and comorbidities 1
• For high-risk patients such as the morbidly obese, alternative techniques like transnasal small-caliber EGD may be considered to minimize sedation requirements and reduce airway complications 5

Documentation Requirements

• The endoscopy report should document the quality of mucosal visualization achieved 1
• Any abnormalities should be documented using established classifications and standard terminology 1
• For surveillance procedures like Barrett's esophagus, inspection time should be recorded 1
• Management recommendations based on endoscopic findings should be clearly documented, including need for follow-up surveillance 1
• Reports should specify the location and number of biopsies taken, using standardized biopsy protocols when appropriate 6

Common Pitfalls to Avoid

• Inadequate mucosal inspection time leading to missed lesions 1
• Failure to use standardized classification systems for findings such as esophagitis or columnar-lined esophagus 6
• Incomplete documentation of important findings such as hiatal hernia size and type 6
• Inappropriate referrals for EGD that expose patients to unnecessary risks 2
• Performing EGD without a clear clinical indication, contributing to higher healthcare costs without improving outcomes 2