12.9 : Endoscopic Procedures I: Esophagogastroduodenoscopy

An Esophagogastroduodenoscopy (EGD) is a diagnostic procedure in which an endoscopist uses a flexible, lighted endoscope to visualize the upper gastrointestinal (GI) tract. The procedure includes visualizing the oropharynx, esophagus, stomach, and the first part of the small intestine, the duodenum.

During an EGD, the endoscope can be used to:

1. Diagnose conditions such as ulcers, GERD, celiac disease, and cancers.
2. Perform biopsies to collect small tissue samples for cancer or celiac disease diagnosis.
3. Treat conditions by removing polyps, treating bleeding, and dilating strictures.

Pre-procedural Preparation: Patients are instructed to fast for 6 to 8 hours beforehand to ensure an empty stomach for clear visualization and reduce aspiration risk. Certain medications, like blood thinners, may require temporary adjustment or discontinuation under medical guidance.

Procedure: During the examination, the patient is positioned on their left side on an examination table to ensure optimal access for the healthcare provider. A nurse inserts an intravenous catheter to administer sedatives, promoting relaxation and comfort throughout the procedure. During the procedure, a mouth guard is placed in the patient's mouth to protect their teeth and the endoscope.

The long, thin, flexible endoscope, equipped with a camera and light source, is gently inserted. It enables real-time visualization of internal structures such as the esophagus, stomach, and duodenum, aiding in promptly detecting abnormalities. Air or carbon dioxide insufflation is routinely performed to enhance visualization and ensure a comprehensive examination. The healthcare provider may take biopsies to further investigate any identified irregularities or perform therapeutic procedures like polyp removal or stricture dilation during the same session.

Once the examination is successfully concluded, the endoscope is gently withdrawn through the esophagus and mouth, completing the procedure.

Post-procedure: Patients are monitored in a designated recovery area after the procedure until the sedative effects have dissipated, prioritizing their safety and well-being. This attentive care ensures a smooth transition from the procedure to a comfortable recovery phase.

Nursing Responsibilities:

Before the Procedure:

1. Patient Education: Explain the procedure, its purpose, and what to expect during the scan. Inform the patient about the need to remain still.
2. Assessment and Preparation: Check for contraindications (e.g., severe coagulopathy, recent myocardial infarction). Ensure 6-8 hours of fasting if required.
3. Consent: Obtain informed consent for the procedure, explaining the risks and benefits.

During the Procedure:

1. Safety and Comfort: Monitor the patient's vital signs, such as oxygen saturation, heart rate, blood pressure, and breathing rate, to ensure stability and quickly detect any changes. Ensure the patient is positioned correctly and safely.
2. Support: Assist the endoscopist by handling instruments and optimizing lighting for better visualization and efficiency.

After the Procedure:

1. Recovery Monitoring: Move the patient to a recovery area and monitor vital signs until they are fully awake. Wait for the gag reflex to return before giving anything orally. Monitor for signs of bleeding or perforation and act quickly if any complications arise.
2. Post-care Education: Educate the patient on post-procedure care, including dietary recommendations, activity restrictions, and signs of potential complications. Advise the patient to consume easily digestible foods for 24 hours following the procedure and to avoid alcohol during this time. Inform the patient to watch for signs of complications, such as severe abdominal pain, vomiting blood, persistent difficulty swallowing, fever, or chest pain. Provide clear instructions for home care, including avoiding strenuous activities, and ensure follow-up appointments are scheduled as needed.

Documentation: Record all relevant information, including the patient's tolerance of the procedure, any complications, and post-procedure instructions given. Inform the healthcare team and ensure patients understand their post-procedure care and follow-up requirements.