Esophagogastroduodenoscopy (EGD) is a medical procedure used to examine the upper gastrointestinal tract, including the lining of the esophagus, stomach, and the first part of the small intestine (duodenum). A thin, flexible tube called an endoscope, equipped with a light and a camera, is passed through the mouth to visualize these internal structures. When combined with dilation, the procedure also includes a therapeutic component focused on widening an abnormally narrowed area, called a stricture. This combined approach allows for both diagnosis and immediate treatment in a single session.
Why This Procedure is Necessary
A doctor orders an EGD with dilation when a patient experiences dysphagia (difficulty swallowing) or the sensation of food getting stuck in the chest. These symptoms typically indicate a stricture, or narrowing, that is impeding the passage of solids and liquids. The EGD portion is diagnostic, allowing the physician to identify the cause of the stricture and check for other abnormalities like ulcers, inflammation, or tumors.
The dilation’s therapeutic function is to physically stretch the scarred tissue causing the blockage. Chronic gastroesophageal reflux disease (GERD) is the most common cause, where long-term acid exposure damages the esophageal lining, leading to scar tissue formation. Other causes of scarring include eosinophilic esophagitis and damage from prior radiation therapy.
The procedure aims to restore the normal flow of food by relieving the blockage, which improves the patient’s quality of life. Repeat dilations are sometimes necessary, depending on the underlying cause and how quickly the scar tissue re-forms.
What to Do Before the Examination
Preparation ensures both patient safety and the clarity of the examination. Patients must fast from all food and drink, including water, for at least six to eight hours before the scheduled time. This fasting prevents the reflux of stomach contents into the lungs during sedation.
A complete and accurate medication list must be provided to the healthcare team in advance. Specific instructions will be given regarding blood-thinning medications, such as aspirin or warfarin, which may need to be temporarily stopped to reduce the risk of bleeding. Patients with diabetes will also receive adjusted guidance on managing their insulin or oral medications due to the fasting requirement. Since sedation is used, all patients must arrange for a responsible adult to drive them home afterward.
The EGD and Dilation Process
The EGD with dilation is typically performed as an outpatient procedure in an endoscopy suite and lasts between 15 and 45 minutes. Upon arrival, an intravenous line administers moderate or deep sedation, ensuring the patient is relaxed or asleep throughout the process. A local anesthetic spray may also be applied to the back of the throat to suppress the gag reflex.
The physician inserts the endoscope through the mouth and guides it into the esophagus, stomach, and duodenum. The camera transmits live images to a monitor, allowing for a detailed inspection to confirm the location and nature of the stricture. Once the narrowed segment is identified, the dilation phase begins using specialized tools passed through the endoscope’s working channel.
Dilation Methods
Dilation is commonly achieved using two methods: balloon dilators or bougie dilators. A deflated balloon is positioned across the stricture and inflated to gently stretch the narrowed tissue. Alternatively, bougie dilators, which are flexible, tapered tubes of increasing thickness, may be passed sequentially over a guide wire. The doctor confirms the success of the dilation by noting the ease with which the endoscope can subsequently pass through the treated area.
What Happens After the Procedure
Following the procedure, the patient is moved to a recovery area and monitored for one to two hours until the sedative effects wear off. Patients may experience temporary side effects, most commonly a mild sore throat from the endoscope passage and a sensation of bloating or gas. These minor effects usually resolve within a day.
The physician provides guidance on resuming a normal diet, often starting with clear liquids and soft foods before returning to regular meals the following day. Patients must be aware of warning signs that could indicate a complication, such as perforation (a tear in the lining of the esophagus). Immediate medical attention is necessary if a patient experiences any of the following:
- Severe chest or abdominal pain
- A fever
- Bloody or dark stools
- Difficulty breathing
Most patients return to their usual, non-strenuous activities the day after the procedure.