upper gastrointestinal (GI) endoscopy; esophagogastroduodenoscopy (EGD)

^[1]^[2]^[3]^[4]^[5]^[6]

Indications

a flexible fiberoptic scope is advanced through the mouth into the upper gastrointestinal tract
this allows for direct visualization of the gastrointestinal mucosa & provides an opportunity for tissue sampling for diagnosis
the esophagus may also be dilated during the procedure
sites of upper gastrointestinal bleeding may be ligated, cauterized or photocoagulated
push enteroscopy advances the endoscope into the jejunum^[1]

can be safely performed in patients with INR < 3.0^[1]
sedation with intravenous benzodiazepine & opioid combination is standard
proton pump inhibitor prior to endoscopy may improve accuracy of screening for Barrett's esophagitis^[2]
repeat EGD may detect source of obscure bleed^[1]
patients should remain in hospital for 72 hours after endoscopy for high-risk peptic ulcer (stage 1A-2B)^[1]
treat low-risk ulcers with oral proton pump inhibitor, resume food, hospital discharge within 12-24 hours
biopsy or resection of gastric polyps^[4]
- resection is indicated for all adenomatous polyps, hyperplastic polyps >= 0.5 cm, & fundic gland polyps >= 1 cm
- gastric sampling or resection is indicated in patients with familial adenomatous polyposis^[4]
biopsy of surrounding mucosa in the setting of multiple adenomatous or hyperplastic polyps^[4]
surveillance endoscopy 1 year after resection of adenomatous polyps^[4]
consider surveillance endoscopy in patients with intestinal metaplasia with risk factors (surveillance interval unclear)
surveillance endoscopy within 6 months of the diagnosis of pernicious anemia^[4]
endoscopic resection & surveillance of intestinal metaplasia with high-grade dysplasia^[4]

↑ ^1.0 ^1.1 ^1.2 ^1.3 ^1.4 Medical Knowledge Self Assessment Program (MKSAP) 11, 15, 16, 17. American College of Physicians, Philadelphia 1998, 2009, 2012, 2015
Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
↑ ^2.0 ^2.1 Hanna S et al, Detection of Barrett's esophagus after endoscopic healing of erosive esophagitis. Am J Gastroenterol 2006, 101:1416 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16863541
↑ Hirota WK, Zuckerman MJ, Adler DG et al ASGE guideline: the role of endoscopy in the surveillance of premalignant conditions of the upper GI tract. Gastrointest Endosc. 2006 Apr;63(4):570-80. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16564854
↑ ^4.0 ^4.1 ^4.2 ^4.3 ^4.4 ^4.5 ^4.6 ASGE Standards of Practice Committee et al. The role of endoscopy in the management of premalignant and malignant conditions of the stomach. Gastrointest Endosc 2015 Apr 30 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25935705 <Internet> http://www.giejournal.org/article/S0016-5107%2815%2902277-4/abstract
↑ Leighton JA The role of endoscopic imaging of the small bowel in clinical practice. Am J Gastroenterol. 2011 Jan;106(1):27-36 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20978483
↑ Upper GI Endoscopy https://www.niddk.nih.gov/health-information/diagnostic-tests/upper-gi-endoscopy