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Kemit Medical Group23077Greenfield,Suite231Southfield,Mf 48075(248)569-2160

Anthony D.Williams,M.D.

Esophagogastroduodenoscopy (EGD)

EGD, also known as Upper gastrointestinal (GI) endoscopy, is a visualexamination of the upper digestive tract. It begins with examination of theesophagus or swallowing tube. Next comes the stomach, a pouch thatmakes acid and breaks the food into smaller particles. Finally the first part ofthe small intestine or duodenum is visualized. The duodenum is where foodmeets bile from the liver and digestive juices from the pancreas.

Reasons for the ExamThere are many disorders which can involve the upper GI tract and whichcan be diagnosed or followed using endoscopy. Common symptoms whichmay lead to endoscopy are heartburn, pains in the stomach or chest,gastrOintestinal bleeding, difficulty in swallowing, nausea and vomiting.Abnormalities which may be detected by EGD include:Ulcers - breakdowns in the lining of the;organsEsophagitis - inflammation of the esophagusGastritis - inflammation of the stomach:InfectionsTumors or Cancer _Obstructions - blockages or narrowings

EquipmentThe endoscope is a thin flexible lighted itube wllich is passed through themouth and is capable of seeing the upper GI tract. It contains a minuteoptically sensitive computer chip in the.ttp which transmits the signal onto avideo screen. Dials permit the physiclan to steer the instrument in everydirection. A channel through the instrument permits suctlonlnq or thecollection of samples. Other instruments can be passed through this channel- to take biopsies, remove polyps, or stop bleeding.

BenefitsEGD is the most accurate means of identifying abnormalities in the upper GItract. It can be performed safely and wlth'minimal discomfort for you. Inaddition to providing a diagnosis, in many cases it enables the physician toperform specific treatment. Bleeding can be controlled, polyps removed, andobstructions relieved. -

Risks and Side EffectsNo test is 100% accurate and lnfrequently EGOcan miss abnorrnalitles whichare present. A mild sore throat occasionaUyfollows the procedure. You mayhave a feeling of bloating which is also.temporary. Complications are veryuncommon. Bleeding can occur following a biopsy or removal of a polyp, but

it is usually minimal and rarely requires a blood transfusion or surgery.Oversedation occurs infrequently and almost always can be reversed. Alocalized irritation of the vein can occur at the IV site resulting in a tenderlump which may last for several weeks. Application of hot moist towels mayrelieve the discomfort. Other risks include complications of underlying heartor lung disease and reactions to one of the sedatives. Perforation (a tear inone of the organs) is exceedingly rare and occurs in approximately one in4,000 cases. Any of these complications could involve hospitalization,emergency surgery, or in an exceptionally rare case death.

Alternative TestingThe primary alternative to an EGD is an upper GI series or barium x-rav. Thisprocedure is less costly, but it is less accurate and it does not permit theapplication of treatments. Some abnormalities such as gastritis would becompletely missed by x-ravs, Tissue and fluid samples cannot be collectedthis way. Other radiographic studies such as an ultrasound or CT scanprovide little information about the lining of the digestive tract which iswhere most of the abnormalities occur.

PreparationFor the physician to have a clear view, the stomach must be empty. It isvery important that you have nothing to eat or drink after midnight theevening before the procedure. If your procedure is scheduled in theafternoon, you may be instructed to have an early clear liquid breakfast. Anexception to this is prescription medication. You can take these on themorning or afternoon of the exam with a few sips of water. It is especiallyimportant to take any high blood pressure or heart medication.If you take any of the following medications notify our office prior to theprocedure because they may need to be stopped or the dosage may need tobe adjusted.Aspirin or aspirin-containing medications (also Alka-Seltzer, Anacin,Bufferin, Ecotrln, BC Powder, Cama)Coumadin (Warfarin)Arthritis MedicationIbuprofen (Motrin, Advil, Medipren, Midol, Nuprin)Piroxicam (Feldene)Naproxen (Naprosvn, Anaprox, Aleve)Sulindac (Clinoril)Diflunisal (Dolobid)Insulin or other .medication for diabetesCarafate

Before the ProcedureYou will be asked to arrive well ahead of the scheduled procedure time.Please bring your insurance cards with you. It is advised that you leave yourvaluables at home or with whomever accompanies you. YOU MUST HAVESOMEONE TO DRIVE YOU HOME OR THE PROCEDURE WILL NOT BEPERFORMED.A brief medical history will be reviewed with you by a nurse. Please bring alist of your current medications and any allergies to medications. You will beasked to remove your clothing and change into a patient gown.

The ProcedureAn intravenous (IV) catheter will be placed into your arm so thatmedications can be given for sedation. It is generally not a painful exam, butthe sedation helps you to relax. Most of the effects of the sedation persistfor 15-60 minutes, and you may not be able to recall the procedureafterwards. Your throat is usually anesthetized with a spray or liquid tominimize the gag reflex. The endoscope is then gently inserted into theupper esophagus and advanced through the upper digestive tract. Theendoscope is small compared to the airway and does not interfere withnormal breathing. You will be monitored closely throughout the exam. Asthe exam takes place, any additional necessary procedures are performed.For example, a biopsy can be performed where a small piece of tissue isremoved for microscopic analysis. A bleeding vessel can be cauterized(burned) or injected with medication to stop the bleeding. A polyp can beremoved with a wire snare and electrocautery.

After the ProcedureYou will remain in the recovery area for one hour or more after theprocedure depending on your vital signs and level of consciousness. Youmay feel bloated from the air used during the exam.The medication given to you during the examination may affect yourreflexes and judgment. Therefore you should not drive a car, operatemachinery, or make any legally binding decisions for the remainder of theday.

ResultsFollowing the exam your physician will discuss the results with you and yourfamily. If you want family members to hear the results of your test, theyshould remain in the waiting area for the duration of your stay.

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