Arpan H. Patel, MD

Upper gastrointestinal (GI) endoscopy provides a means for accurate diagnosis and therapy of upper GI diseases. The purpose of this chapter is to provide an overview of upper GI endoscopy, its clinical indications, contraindications, the procedure itself, and a summary of known adverse events. It is not intended to be a comprehensive source of instruction. Endoscopic technique and interpretation are best taught by an experienced endoscopist, supplemented by a review of recent inclusive texts1,2,3,4 that outline technique and pathology in detail. Training guidelines have been established by professional societies.5


  • 1. The patient should have nothing by mouth for 6 hours prior to the procedure. If this is not possible due to the need for emergent esophagogastroduodenoscopy (EGD), the stomach should be evacuated by means of an orogastric or nasogastric lavage. Intubation for airway protection should be considered in patients who are having vigorous upper GI bleeding in
    which it is not possible to completely evacuate the stomach, such as in variceal bleeding and in patients with decreased consciousness.

  • 2. Review the patient’s chart, including x-rays and coagulation studies.

  • 3. See the patient prior to the procedure. Be certain the study is indicated and that the patient understands the risks and benefits and agrees to the procedure. Obtain written informed consent from the patient or his or her legal proxy.

  • 4. Write a preprocedure note that documents cardiovascular and airway assessment, comorbidities, and informed consent.

  • 5. Start an intravenous (IV) line; anesthetize the patient’s throat with a topical agent such as lidocaine spray, and attach the pulse oximeter. Oxygen saturation, blood pressure, and pulse rate are routinely monitored during procedures requiring conscious sedation.

  • 6. Administer a short-acting narcotic such as fentanyl through the IV line. There should be at least a 2-minute pause in between doses given slight delay in medication effect and risk of respiratory depression with escalating narcotic dosage.

  • 7. If needed, slowly administer midazolam (0.75 to 2 mg) intravenously until an appropriate level of sedation is reached. Watch the patient carefully for respiratory depression and give preoperative medication cautiously in elderly or malnourished patients.

May 29, 2020 | Posted by in GASTROENTEROLOGY | Comments Off on Esophagogastroduodenoscopy

Full access? Get Clinical Tree

Get Clinical Tree app for offline access