Endoscopic Procedures I: Esophagogastroduodenoscopy

An esophagogastroduodenoscopy (EGD) enables visualization of the oropharynx, esophagus, stomach, and proximal duodenum using a flexible, lighted endoscope. The procedure provides real-time imaging of the upper gastrointestinal tract, allowing healthcare providers to detect abnormalities and perform both diagnostic and therapeutic interventions in a single session.

EGD helps diagnose GERD, peptic ulcers, gastritis, Barrett's esophagus, celiac disease, and cancers of the upper GI tract. The procedure enables direct visualization of the esophageal and gastric lining, allowing clinicians to identify mucosal abnormalities and collect tissue samples through biopsy for further investigation when irregularities are detected.

Insufflation with air or carbon dioxide distends the gastrointestinal tract, enhancing visibility of the mucosal surfaces and internal structures. This technique ensures comprehensive examination of the esophagus, stomach, and duodenum, enabling the endoscopist to promptly detect abnormalities and perform therapeutic interventions such as polyp removal or stricture dilation.

During EGD, healthcare providers can remove polyps, treat bleeding lesions, dilate strictures, and collect tissue biopsies. These therapeutic procedures are performed during the same session as diagnostic examination, allowing for immediate intervention when abnormalities are identified, reducing the need for separate procedures.

Pre-procedure nursing responsibilities include explaining the procedure and obtaining informed consent, instructing patients to fast for 6 to 8 hours beforehand to ensure an empty stomach, assessing for contraindications, and checking medication history. Nurses must verify that blood thinners or other medications have been appropriately adjusted under medical guidance before the procedure begins.

During the procedure, nurses monitor vital signs including oxygen saturation, heart rate, blood pressure, and breathing rate to ensure patient stability. A mouth guard protects the teeth and endoscope, while an intravenous catheter delivers sedatives for patient relaxation. Nurses assist the endoscopist by handling instruments and optimizing visualization conditions.

After EGD, patients are monitored in a recovery area until sedative effects dissipate and the gag reflex returns. Nurses observe for complications like bleeding or perforation, monitor vital signs, and educate patients on consuming easily digestible foods for 24 hours and avoiding alcohol. Patients should watch for severe abdominal pain, vomiting blood, persistent difficulty swallowing, fever, or chest pain.