Esophagogastroduodenoscopy
Encyclopedia
For other expansions of the initialism "OGD", see the disambiguation page
OGD
OGD is a three-letter initialism with the following meanings:* Open Government Data * The British medical abbreviation for oesophagogastroduodenoscopy, a diagnostic endoscopic procedure that visualizes the upper part of the gastrointestinal tract up to the duodenum.* The IATA airport code for...

.

In medicine
Medicine
Medicine is the science and art of healing. It encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness....

 (gastroenterology
Gastroenterology
Gastroenterology is the branch of medicine whereby the digestive system and its disorders are studied. The name is a combination of three Ancient Greek words gaster , enteron , and logos...

), esophagogastroduodenoscopy is a diagnostic
Medical diagnosis
Medical diagnosis refers both to the process of attempting to determine or identify a possible disease or disorder , and to the opinion reached by this process...

 endoscopic
Endoscopy
Endoscopy means looking inside and typically refers to looking inside the body for medical reasons using an endoscope , an instrument used to examine the interior of a hollow organ or cavity of the body. Unlike most other medical imaging devices, endoscopes are inserted directly into the organ...

 procedure that visualizes the upper part of the gastrointestinal tract
Gastrointestinal tract
The human gastrointestinal tract refers to the stomach and intestine, and sometimes to all the structures from the mouth to the anus. ....

 up to the duodenum
Duodenum
The duodenum is the first section of the small intestine in most higher vertebrates, including mammals, reptiles, and birds. In fish, the divisions of the small intestine are not as clear and the terms anterior intestine or proximal intestine may be used instead of duodenum...

. It is considered a minimally invasive procedure since it does not require an incision into one of the major body cavities and does not require any significant recovery after the procedure (unless sedation
Sedation
Sedation is the reduction of irritability or agitation by administration of sedative drugs, generally to facilitate a medical procedure or diagnostic procedure...

 or anesthesia
Anesthesia
Anesthesia, or anaesthesia , traditionally meant the condition of having sensation blocked or temporarily taken away...

 has been used). However, a sore throat
Pharyngitis
Pharyngitis is an inflammation of the throat or pharynx. In most cases it is quite painful, and is the most common cause of a sore throat.Like many types of inflammation, pharyngitis can be acute – characterized by a rapid onset and typically a relatively short course – or chronic....

 is common.

Alternative names

Esophagogastroduodenoscopy may be abbreviated EGD, or OGD if one uses the British spelling oesophagogastroduodenoscopy. It is also called upper GI endoscopy (UGIE), gastroscopy or simply endoscopy
Endoscopy
Endoscopy means looking inside and typically refers to looking inside the body for medical reasons using an endoscope , an instrument used to examine the interior of a hollow organ or cavity of the body. Unlike most other medical imaging devices, endoscopes are inserted directly into the organ...

 (since it is the most commonly performed type of endoscopy, the ambiguous term 'endoscopy' refers to EGD by default).

Diagnostic

  • Unexplained anemia
    Anemia
    Anemia is a decrease in number of red blood cells or less than the normal quantity of hemoglobin in the blood. However, it can include decreased oxygen-binding ability of each hemoglobin molecule due to deformity or lack in numerical development as in some other types of hemoglobin...

     (usually along with a colonoscopy
    Colonoscopy
    Colonoscopy is the endoscopic examination of the large bowel and the distal part of the small bowel with a CCD camera or a fiber optic camera on a flexible tube passed through the anus. It may provide a visual diagnosis and grants the opportunity for biopsy or removal of suspected...

    )
  • Upper gastrointestinal bleeding
    Upper gastrointestinal bleeding
    Upper gastrointestinal bleeding refers to hemorrhage in the upper gastrointestinal tract. The anatomic cut-off for upper GI bleeding is the ligament of Treitz, which connects the fourth portion of the duodenum to the diaphragm near the splenic flexure of the colon.Upper GI bleeds are considered...

     as evidenced by hematemesis
    Hematemesis
    Hematemesis or haematemesis is the vomiting of blood. The source is generally the upper gastrointestinal tract. Patients can easily confuse it with hemoptysis , although the latter is more common.-Signs:...

     or melena
    Melena
    In medicine, melena or melaena refers to the black, "tarry" feces that are associated with gastrointestinal hemorrhage. The black color is caused by oxidation of the iron in hemoglobin during its passage through the ileum and colon.-Melena vs...

  • Persistent dyspepsia
    Dyspepsia
    Dyspepsia , also known as upset stomach or indigestion, refers to a condition of impaired digestion. It is a medical condition characterized by chronic or recurrent pain in the upper abdomen, upper abdominal fullness and feeling full earlier than expected when eating...

     in patients over the age of 45 years
  • Heartburn and chronic acid reflux - this can lead to a precancerous lesion called Barrett's esophagus
    Barrett's esophagus
    Barrett's esophagus refers to an abnormal change in the cells of the inferior portion of the esophagus. A positive diagnosis generally requires observing specific macroscopic and microscopic changes...

  • Persistent vomiting
  • Dysphagia
    Dysphagia
    Dysphagia is the medical term for the symptom of difficulty in swallowing. Although classified under "symptoms and signs" in ICD-10, the term is sometimes used as a condition in its own right. Sufferers are sometimes unaware of their dysphagia....

     - difficulty in swallowing
  • Odynophagia
    Odynophagia
    Odynophagia is painful swallowing, in the mouth or esophagus. It can occur with or without dysphagia, or difficult swallowing....

     - painful swallowing

Surveillance

  • Surveillance of Barrett's esophagus
    Barrett's esophagus
    Barrett's esophagus refers to an abnormal change in the cells of the inferior portion of the esophagus. A positive diagnosis generally requires observing specific macroscopic and microscopic changes...

  • Surveillance of gastric ulcer or duodenal ulcer
  • Occasionally after gastric surgery

Confirmation of diagnosis/biopsy

  • Abnormal barium swallow
    Barium swallow
    A barium swallow is a medical imaging procedure used to examine the upper GI tract, which includes the esophagus and, to a lesser extent, the stomach.-Principle:...

     or barium meal
    Barium meal
    A barium meal, also known as an upper gastrointestinal series is a procedure in which radiographs of the esophagus, stomach and duodenum are taken after barium sulfate is ingested by a patient...

  • Confirmation of celiac disease (via biopsy)

Therapeutic

  • Treatment (banding/sclerotherapy) of esophageal varices
  • Injection therapy (e.g. epinephrine
    Epinephrine
    Epinephrine is a hormone and a neurotransmitter. It increases heart rate, constricts blood vessels, dilates air passages and participates in the fight-or-flight response of the sympathetic nervous system. In chemical terms, adrenaline is one of a group of monoamines called the catecholamines...

     in bleeding lesions)
  • Cutting off of larger pieces of tissue with a snare device (e.g. polyps
    Polyp (medicine)
    A polyp is an abnormal growth of tissue projecting from a mucous membrane. If it is attached to the surface by a narrow elongated stalk, it is said to be pedunculated. If no stalk is present, it is said to be sessile. Polyps are commonly found in the colon, stomach, nose, sinus, urinary bladder...

    , endoscopic mucosal resection)
  • Application of cautery
    Cauterization
    The medical practice or technique of cauterization is the burning of part of a body to remove or close off a part of it in a process called cautery, which destroys some tissue, in an attempt to mitigate damage, remove an undesired growth, or minimize other potential medical harmful possibilities...

     to tissues
  • Removal of foreign bodies
    Foreign body
    A foreign body is any object originating outside the body. In machinery, it can mean any unwanted intruding object.Most references to foreign bodies involve propulsion through natural orifices into hollow organs....

     (e.g. food) that have been ingested
  • Tamponade of bleeding esophageal varices
    Esophageal varices
    In medicine , esophageal varices are extremely dilated sub-mucosal veins in the lower esophagus...

     with a balloon
    Balloon tamponade
    Balloon tamponade usually refers to the use of balloons inserted into the esophagus or stomach, and inflated to stop refractory bleeding from vascular structures—including esophageal varices and gastric varices -- in the upper gastrointestinal tract....

  • Application of photodynamic therapy for treatment of esophageal malignancies
  • Endoscopic drainage of pancreatic pseudocyst
    Pancreatic pseudocyst
    A pancreatic pseudocyst is a circumscribed collection of fluid rich in pancreatic enzymes, blood, and necrotic tissue, typically located in the lesser sac of the abdomen....

  • Tightening the lower esophageal sphincter
  • Dilating or stenting of stenosis or achalasia
    Achalasia
    Achalasia , also known as esophageal achalasia, achalasia cardiae, cardiospasm, and esophageal aperistalsis, is an esophageal motility disorder involving the smooth muscle layer of the esophagus and the lower esophageal sphincter...

  • Percutaneous endoscopic gastrostomy
    Percutaneous endoscopic gastrostomy
    Percutaneous endoscopic gastrostomy is an endoscopic medical procedure in which a tube is passed into a patient's stomach through the abdominal wall, most commonly to provide a means of feeding when oral intake is not adequate. The procedure is an alternative to surgical gastrostomy insertion, and...

     (feeding tube placement)
  • Endoscopic retrograde cholangiopancreatography
    Endoscopic retrograde cholangiopancreatography
    Endoscopic retrograde cholangiopancreatography is a technique that combines the use of endoscopy and fluoroscopy to diagnose and treat certain problems of the biliary or pancreatic ductal systems...

     (ERCP) combines EGD with fluoroscopy
    Fluoroscopy
    Fluoroscopy is an imaging technique commonly used by physicians to obtain real-time moving images of the internal structures of a patient through the use of a fluoroscope. In its simplest form, a fluoroscope consists of an X-ray source and fluorescent screen between which a patient is placed...

  • Endoscopic ultrasound
    Endoscopic ultrasound
    Endoscopic ultrasound or echo-endoscopy is a medical procedure in endoscopy is combined with ultrasound to obtain images of the internal organs in the chest and abdomen. It can be used to visualize the wall of these organs, or to look at adjacent structures...

     (EUS) combines EGD with 5–12 MHz ultrasound
    Ultrasound
    Ultrasound is cyclic sound pressure with a frequency greater than the upper limit of human hearing. Ultrasound is thus not separated from "normal" sound based on differences in physical properties, only the fact that humans cannot hear it. Although this limit varies from person to person, it is...

     imaging

Newer interventions

  • Endoscopic trans-gastric laparoscopy
  • Placement of gastric balloons in bariatric surgery
    Bariatric surgery
    Bariatric surgery includes a variety of procedures performed on people who are obese. Weight loss is achieved by reducing the size of the stomach with an implanted medical device or through removal of a portion of the stomach or by resecting and re-routing the small intestines...


Equipment

  • Endoscope
    • Non-coaxial optic fiber
      Optical fiber
      An optical fiber is a flexible, transparent fiber made of a pure glass not much wider than a human hair. It functions as a waveguide, or "light pipe", to transmit light between the two ends of the fiber. The field of applied science and engineering concerned with the design and application of...

       system to carry light to the tip of the endoscope
    • A chip camera at the tip of the endoscope - this has now replaced the coaxial optic fibers of older scopes that were prone to damage and consequent loss of picture quality
    • Irrigation channel to clean the lens
    • Suction/Insufflation/Working channels - these may be in the form of one or more channels
    • Control handle - this houses the controls
  • Stack
    • Light source
    • Insufflator
    • Suction
    • Electrosurgical
      Electrosurgery
      Electrosurgery is the application of a high-frequency electric current to biological tissue as a means to cut, coagulate, desiccate, or fulgurate tissue. . Its benefits include the ability to make precise cuts with limited blood loss...

       unit
    • Video recorder/photo printer
  • Instruments
    • Biopsy forceps
    • Snares
    • Injecting needles

Procedure

The patient is kept NPO (Nil per os) or NBM (Nothing By Mouth)
Nil per os
Nil per os is a medical instruction meaning to withhold oral food and fluids from a patient for various reasons. It is a Latin phrase which translates as "nothing through the mouth". In the United Kingdom it is translated as nil by mouth .Typical reasons for NPO instructions are the prevention...

 that is, told not to eat, for at least 4–6 hours before the procedure. Most patients tolerate the procedure with only topical anesthesia
Topical anesthetic
A topical anesthetic is a local anesthetic that is used to numb the surface of a body part. They can be used to numb any area of the skin as well as the front of the eyeball, the inside of the nose, ear or throat, the anus and the genital area. Topical anesthetics are available in creams,...

 of the oropharynx
Oropharynx
The Oropharynx reaches from the Uvula to the level of the hyoid bone.It opens anteriorly, through the isthmus faucium, into the mouth, while in its lateral wall, between the two palatine arches, is the palatine tonsil....

 using lidocaine
Lidocaine
Lidocaine , Xylocaine, or lignocaine is a common local anesthetic and antiarrhythmic drug. Lidocaine is used topically to relieve itching, burning and pain from skin inflammations, injected as a dental anesthetic or as a local anesthetic for minor surgery.- History :Lidocaine, the first amino...

 spray. However, some patients may need sedation and the very anxious/agitated patient may even need a general anesthetic. Informed consent
Informed consent
Informed consent is a phrase often used in law to indicate that the consent a person gives meets certain minimum standards. As a literal matter, in the absence of fraud, it is redundant. An informed consent can be said to have been given based upon a clear appreciation and understanding of the...

 is obtained before the procedure. The main risks are bleeding and perforation. The risk is increased when a biopsy or other intervention is performed.

The patient lies on his/her left side with the head resting comfortably on a pillow. A mouth-guard is placed between the teeth to prevent the patient from biting on the endoscope. The endoscope is then passed over the tongue and into the oropharynx. This is the most uncomfortable stage for the patient. Quick and gentle manipulation under vision guides the endoscope into the esophagus. The endoscope is gradually advanced down the esophagus making note of any pathology. Excessive insufflation
Insufflation (medicine)
Insufflation is the practice of inhaling a substance. Insufflation has limited medical use, but is a common route of administration with many respiratory drugs used to treat conditions in the lungs and paranasal sinus .The technique is common for many recreational drugs and is also used for some...

 of the stomach is avoided at this stage. The endoscope is quickly passed through the stomach and through the pylorus to examine the first and second parts of the duodenum
Duodenum
The duodenum is the first section of the small intestine in most higher vertebrates, including mammals, reptiles, and birds. In fish, the divisions of the small intestine are not as clear and the terms anterior intestine or proximal intestine may be used instead of duodenum...

. Once this has been completed, the endoscope is withdrawn into the stomach and a more thorough examination is performed including a J-maneuver. This involves retroflexing the tip of the scope so it resembles a 'J' shape in order to examine the fundus
Fundus (stomach)
The fundus of the stomach is the left portion of the stomach's body, and is marked off from the remainder of the body by a plane passing horizontally through the cardiac orifice....

 and gastroesophageal junction. Any additional procedures are performed at this stage. The air in the stomach is aspirated before removing the endoscope. Still photograph
Photograph
A photograph is an image created by light falling on a light-sensitive surface, usually photographic film or an electronic imager such as a CCD or a CMOS chip. Most photographs are created using a camera, which uses a lens to focus the scene's visible wavelengths of light into a reproduction of...

s can be made during the procedure and later shown to the patient to help explain any findings.

In its most basic use, the endoscope is used to inspect the internal anatomy of the digestive tract. Often inspection alone is sufficient, but biopsy
Biopsy
A biopsy is a medical test involving sampling of cells or tissues for examination. It is the medical removal of tissue from a living subject to determine the presence or extent of a disease. The tissue is generally examined under a microscope by a pathologist, and can also be analyzed chemically...

 is a very valuable adjunct to endoscopy. Small biopsies can be made with a pincer (biopsy forceps
Forceps
Forceps or forcipes are a handheld, hinged instrument used for grasping and holding objects. Forceps are used when fingers are too large to grasp small objects or when many objects need to be held at one time while the hands are used to perform a task. The term 'forceps' is used almost exclusively...

) which is passed through the scope and allows sampling of 1 to 3 mm pieces of tissue under direct vision. The intestinal mucosa heals quickly from such biopsies.

Biopsy allows the pathologist to render an opinion on later histologic examination of the biopsy tissue with light microscopy and/or immunohistochemistry
Immunohistochemistry
Immunohistochemistry or IHC refers to the process of detecting antigens in cells of a tissue section by exploiting the principle of antibodies binding specifically to antigens in biological tissues. IHC takes its name from the roots "immuno," in reference to antibodies used in the procedure, and...

. Biopsied material can also be tested on urease
Urease
Urease is an enzyme that catalyzes the hydrolysis of urea into carbon dioxide and ammonia. The reaction occurs as follows:In 1926, James Sumner showed that urease is a protein. Urease is found in bacteria, yeast, and several higher plants. The structure of urease was first solved by P.A...

 to identify Helicobacter pylori
Helicobacter pylori
Helicobacter pylori , previously named Campylobacter pyloridis, is a Gram-negative, microaerophilic bacterium found in the stomach. It was identified in 1982 by Barry Marshall and Robin Warren, who found that it was present in patients with chronic gastritis and gastric ulcers, conditions that were...

.

Complications

The complication rate is about 1 in 1000. They include:
  • aspiration, causing aspiration pneumonia
    Aspiration pneumonia
    Aspiration pneumonia is bronchopneumonia that develops due to the entrance of foreign materials into the bronchial tree, usually oral or gastric contents...

  • bleeding
  • perforation
  • cardiopulmonary problems

Limitations

Problems of gastrointestinal function are usually not well diagnosed by endoscopy since motion or secretion of the gastrointestinal tract are not easily inspected by EGD. Nonetheless, findings such as excess fluid or poor motion of gut during endoscopy can be suggestive of disorders of function. Irritable bowel syndrome
Irritable bowel syndrome
Irritable bowel syndrome is a diagnosis of exclusion. It is a functional bowel disorder characterized by chronic abdominal pain, discomfort, bloating, and alteration of bowel habits in the absence of any detectable organic cause. In some cases, the symptoms are relieved by bowel movements...

 and functional dyspepsia is not diagnosed with EGD, but EGD may be helpful in excluding other diseases that mimic these common disorders.
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