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Endoscopy
Esophagogastroduodenoscopy (EGD)
Endoscopy (EGD) is the visual examination of the upper gastrointestinal tract which includes the esophagus, stomach, and duodenum (first portion of the small intestine) using a lighted, thin flexible instrument. The instrument is approximately 4’ long with a steerable end to direct its safe passage through the upper GI tract. The lighting system uses fiberoptics, or more commonly, a video computer chip to produce an image that may be watched on a video screen monitor.
Endoscopy allows for accurate and safe direct inspection of the inner lining of the GI tract as a diagnostic instrument. A channel through the middle of the scope permits insertion of other instruments to enhance the capabilities of the exam. Commonly, a biopsy may be taken by passing a biopsy forceps onto a particular area that is being examined. With a small pinch, tissue is removed with this device. This tissue is then sent to the pathology lab for microscopic examination. The result of these biopsies are then available several days later. Treatment modalities may also be applied. This may involve cautery or injection of a bleeding ulcer or blood vessel, dilation (stretching) of a narrowed section or removal of lesions. A polyp is a growth more commonly found within the colon that can rarely develop in the stomach. When polyps are detected, they can often be removed by passing a wire snare through the channel of the scope and grasping the base of the polyp where it attaches to the stomach wall. An electrical current is then applied to simultaneously cut the polyp free and to cauterize the site to minimize the risk of bleeding. The polyp tissue is then removed and sent to the pathology lab for microscopic examination.
EGD (Endoscopy) Preparation Instructions
You are scheduled for an
endoscopy, an examination of the upper GI tract (esophagus, stomach, and
duodenum) with a lighted flexible scope. During the endoscopy, if an abnormality is seen, it will usually be
biopsied at that time. This involves removing a portion or all of the
abnormal area for processing and subsequent examination under a
microscope.
Plan on being with us
for a total of 2-3 hours. When
you arrive, you will need to complete your paperwork, then change into a
patient gown. The nursing staff will perform a brief assessment and place
an I.V. You will then be
brought into the procedure room, be sedated, and undergo the endoscopy
examination. The endoscopy itself takes about 15 minutes. After the
examination, you will rest in the recovery area while the sedative wears
off. Due to the
sedation, you may not remember your conversation with the doctor after the
endoscopy. Please have a family member or friend stay with you that can
also speak with the doctor and nurses after the procedure. By law, you can not drive the
rest of the day of the endoscopy. We advise you to take the entire day off
work.
It is important for you to bring with you a list of all prescription
medications and non-prescription products (over-the-counter,
anti-inflammatory, herbal, vitamins, etc) you are taking and a list of any
medications you are allergic to.
Five or more
days prior to endoscopy:
Three
days prior to endoscopy:
One Day
prior to endoscopy:
The day of endoscopy:
Do not have anything to eat or drink after midnight the night before your endoscopy!
Should you have any questions regarding your preparation or procedure, please do not hesitate to call our office, (513) 751-6667
Results
If no biopsies are needed, then the final results of the examination can be given to you that day. Due to the sedative medications and amnesia effect, it is preferable to have someone with you with whom the results can be discussed that day. Biopsy results are generally available within one week and may be discussed in the office or by telephone. If at any time you have any questions regarding your test or its results, we encourage you to call us directly for additional explanation and information. We prepare a typewritten report for your primary physician and any other physicians that need a copy of the report for your files. A copy of any biopsies obtained are also sent with our typewritten report.
Benefits of Endoscopy
Endoscopy is performed to diagnose and/or treat many problems within the upper GI tract. Endoscopy is felt to be, in almost all circumstances, "the gold standard test" given its high degree of accuracy. As discussed above, if a lesion abnormalities are found, endoscopy can also obtain additional specimens for biopsy and other examination, that is, it has the ability to "treat" and not "just look." If there is a bleeding site identified, treatment can be given at that time to attempt to stop the bleeding. Other treatments (i.e. laser) are also available in specific circumstances.
Alternatives to Endoscopy
Alternative testing to endoscopy is primarily an upper GI-Barium Examination (also known as an Upper GI). The Upper GI is performed by drinking a barium solution while X-rays are taken. No I.V.’s or sedatives are usually given for X-ray examinations.
Side Effects and Risks of Endoscopy
During the endoscopy, air is used to inflate and improve visualization. Prior to completion of the test, as much air as possible is suctioned out but usually cannot be completely removed. This may lead to some bloating, distention and/or discomfort after the procedure. Serious risks with endoscopy are uncommon (less than one in one thousand) but can include bleeding, perforation (making a hole), infection or a reaction to one of the sedative medications. A diagnostic error or oversight can rarely occur. Other risks include a complication from an unrelated disease such as heart attack or stroke; death is extremely rare, but remains a remote possibility.
Informed Consent
This is an example of the informed consent statement that you will be asked to read and sign at the time of endoscopy.
Consent for Medical Procedure and Acknowledgment of Risk Information for Esophagogastroduodenoscopy (EGD)
Nature and Purpose of Procedure: I understand that current medical practice requires my prior informed consent and acknowledgment of risk information before proceeding with any medical procedure. EGD consists of the passage of a flexible lighted tube (endoscope) through the mouth and into the esophagus, stomach, and small intestine to examine the upper portion of the digestive tract. A local anesthetic may be applied to the throat to numb it and decrease the tendency to gag; usually intravenous sedation is given to minimize the possibility of discomfort. Due to this sedation, I understand that I will be unable to drive and must have someone with me to drive me home. If necessary, a very small piece of tissue will be taken to send to the laboratory for analysis; if a polyp is seen, it may be removed through the endoscope; if a narrowing of the esophagus is present, it may be widened by passing a thin tube or balloon (dilator) through the narrowing.
Reasonably Known Risks Associated with EGD: The procedure is generally considered to be of low risk. Some, but not all, of the known risks include the following: a localized irritation of the vein may occur at the site of intravenous injection of medication; a tear in a blood vessel, or in the wall of the gastrointestinal tract itself, may occur; this could lead to bleeding or leaking of intestinal contents into the abdominal cavity; the bleeding usually stops on its own but could require transfusion or surgery; a tear in the wall of the gastrointestinal tract may seal over by itself but would require an operation if leakage of gastrointestinal fluids occurred. Other risks include an adverse reaction to a medication or a complication from an unrelated disease such as heart attack or stroke; death is extremely rare, but remains a remote possibility.
Authorization: I authorize Dr (s) ______________________ and his/her (their) associates or assistants to perform the above mentioned procedure to the extent deemed necessary. I understand that during the course of the procedure, unforeseen conditions may become apparent which would require an extension of the original procedure or even a different procedure; I authorize the above-named physician(s) to perform such procedures or transfer to a hospital as deemed necessary and advisable in the exercise of his/her (their) professional judgment.
Alternative Procedures: Although gastrointestinal endoscopy is considered a safe and accurate way to examine the gastrointestinal tract, there are other diagnostic or therapeutic procedures which may be available to you, usually including x-rays and/or surgery. These may be discussed with you by your physician as deemed appropriate to your individual case. If you have any questions or concerns about alternative procedures or risks, you are encouraged to discuss those with your physician prior to signing this consent.
Consent and Acknowledgment: By signing this form, I acknowledge that I have read and understand this consent form and have received sufficient information regarding EGD to give my informed consent. I understand that I may at any time request more detailed information of any other and less likely problems or complications. I am aware that the practice of medicine is not an exact science and that the nature of the procedure, anticipated results, and potential complications cannot always be anticipated with complete accuracy. For this reason, I acknowledge that prior to signing this form I understand this information and I have been given a complete opportunity to ask any and all questions of my physician, which I may wish answered concerning the procedure, its risks, and alternative procedures.
Related Sites
American Gastroenterological Association (AGA),
http://www.gastro.org Ohio Society of Gastroenterology Nurses & Associates (osgna) http://www.osgna.org
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