Synonym/Acronym
Esophagoscopy, gastroscopy, upper GI endoscopy, EGD.
Rationale
To visualize and assess the esophagus, stomach, and upper portion of the duodenum to assist in diagnosis of bleeding, ulcers, inflammation, tumor, and cancer.
Patient Preparation
There are no activity restrictions unless by medical direction. The patient may be given additional instructions about following a special diet for 1 or 2 days before the procedure. Instruct the patient to fast and restrict fluids for 6 to 8 hr prior to the procedure to reduce the risk of aspiration related to nausea and vomiting. The patient may be required to be NPO after midnight. The American Society of Anesthesiologists has fasting guidelines for risk levels according to patient status. More information can be located at www.asahq.org.
The patient may be instructed to take a laxative, an enema, or a rectal laxative suppository.
Regarding the patient’s risk for bleeding, the patient should be instructed to avoid taking natural products and medications with known anticoagulant, antiplatelet, or thrombolytic properties or to reduce dosage, as ordered, prior to the procedure. Number of days to withhold medication is dependent on the type of anticoagulant. Note the last time and dose of medication taken. Protocols may vary among facilities.
Patients on beta blockers before the surgical procedure should be instructed to take their medication as ordered during the perioperative period.
Normal Findings
- Esophageal mucosa is normally yellow-pink. At about 9 in. from the incisor teeth, a pulsation indicates the location of the aortic arch. The gastric mucosa is orange-red and contains rugae. The proximal duodenum is reddish and contains a few longitudinal folds, whereas the distal duodenum has circular folds lined with villi. No abnormal structures or functions are observed in the esophagus, stomach, or duodenum.
Study type: Endoscopy; related body system: Digestive system.
EGD allows direct visualization of the upper GI tract mucosa, which includes the esophagus, stomach, and upper portion of the duodenum, by means of a flexible endoscope. The standard flexible fiberoptic endoscope contains three channels that allow passage of the instruments needed to perform therapeutic or diagnostic procedures, such as biopsies or cytology washings. The endoscope, a multichannel instrument, allows visualization of the GI tract linings, insufflation of air, aspiration of fluid, removal of foreign bodies by suction or by snare or forceps, and passage of a laser beam for obliteration of abnormal tissue or control of bleeding. Direct visualization yields greater diagnostic data than is possible through radiological procedures, and therefore EGD is rapidly replacing upper GI series as the diagnostic procedure of choice.
Contraindications
Patients with a bleeding disorder.
Patients with unstable cardiopulmonary status, blood coagulation defects, or cholangitis, unless the patient received prophylactic antibiotic therapy before the test (otherwise the examination must be rescheduled).
Patients with known aortic arch aneurysm, large esophageal Zenker diverticulum, recent GI surgery, esophageal varices, or known esophageal perforation.
Patients who are unable to be cooperative during the procedure.
Factors That May Alter the Results of the Study
- Gas or food in the GI tract resulting from inadequate cleansing or failure to restrict food intake before the study.
- Retained barium from a previous radiological procedure.
Abnormal Findings Related to
Potential Nursing Problems: Assessment & Nursing Diagnosis
| Problems | Signs and Symptoms |
|---|
| Nutrition(insufficient—related to pain, bleeding, nausea, vomiting, excessive alcohol intake, anorexia; inability to ingest, absorb, or digest food) | Weight loss, emaciation, malabsorption, poor intake, loss of interest in food, weakness, hair loss, pallor | | Pain (related to gastric irritation associated with the use of acetylsalicylic acid and NSAIDs, excessive use of coffee or tea, ingestion of highly spicy foods; gastric erosion; inflammation) | Weight loss; self-report of pain; nausea; vomiting, relief of pain with the use of antacids; intermittent pain located in the abdomen or epigastric area; cramping; distention; coffee ground emesis |
|
Before the Study: Planning and Implementation
Teaching the Patient What to Expect
- Discuss how this procedure can assist in assessing the esophagus and GI tract.
- Explain that the procedure takes about 20 to 30 min and is performed in a GI laboratory or radiology department.
- Review the procedure with the patient.
- Explain that pregnancy testing may be required.
- Discuss how there may be moments of discomfort or pain when the IV line is inserted allowing for infusion of fluids such as saline, anesthetics, sedatives, medications used in the procedure, or emergency medications.
- Explain that some discomfort or pain may be experienced when the endoscope is inserted.
- Explain that the throat will be anesthetized with a spray or swab for comfort and to decrease the gag reflex prior to endoscope insertion.
- Explain that it will not be possible to speak during the procedure, but breathing will not be affected.
- Ensure ordered premedication has been administered.
Procedural Information
- Baseline vital signs will be recorded and monitored throughout the procedure.
- An emesis basin is provided to collect the increased saliva produced if the gag reflex is impaired.
- Positioning for this study is on an examination table in the left lateral decubitus position with the neck slightly flexed forward.
- The endoscope is passed through the mouth with a dental suction device in place to drain secretions.
- A bite block may be used to support the jaw.
- A side-viewing flexible, fiberoptic endoscope is advanced, and visualization of the GI tract is started.
- Air is insufflated to distend the upper GI tract, as needed.
- Biopsy specimens are obtained and/or endoscopic surgery is performed.
- Specimens are promptly transported to the laboratory for processing and analysis.
- At the end of the procedure, excess air and secretions are aspirated through the scope and the endoscope is removed.
- The needle is removed, and a pressure dressing is applied over the puncture site.
Potential Nursing Actions
Make sure a written and informed consent has been signed prior to the procedure and before administering any medications.
Safety Considerations
- Anticoagulants, aspirin, and other salicylates should be discontinued by medical direction for the appropriate number of days prior to a procedure in which bleeding is a potential complication.
- Institute fall precautions until the sedation wears off.
After the Study: Implementation & Evaluation Potential Nursing Actions
Avoiding Complications
- Monitor the patient for complications related to the procedure.
- Discuss immediately reportable symptoms such as excessive bleeding, difficulty breathing, expectoration of blood, fever.
- Monitor for bleeding and cardiac dysrhythmias.
- Observe/assess the needle insertion site for bleeding, inflammation, or hematoma formation.
- Monitor for indications of esophageal perforation (i.e., painful swallowing with neck movement, substernal pain with respiration, shoulder pain or dyspnea, abdominal or back pain, cyanosis, or fever).
Treatment Considerations
- Follow post-procedure vital sign and assessment protocol.
- Restrict eating or drinking after the procedure until the gag reflex returns; then allow the patient to eat lightly for 12 to 24 hr.
- Resume usual activity and diet in 24 hr or as tolerated after the examination, as directed by the HCP.
Pain
- Use an easily understandable age and culturally appropriate pain rating scale.
- Advise the patient to report pain that occurs within 1 to 4 hr of eating or in the middle of the night.
- Administer prescribed medications (antibiotics, antacids, H2 receptor antagonist, proton pump inhibitor) for pain management.
- Collaborate with the patient and HCP to identify the pain management modality that works best.
- Discuss treating throat soreness and hoarseness with lozenges and warm gargles when the gag reflex returns.
- Inform the patient that any belching, bloating, or flatulence is the result of air insufflation and is temporary.
Nutritional Considerations
- Discuss completing a daily weight, calorie count, and dietary consult.
- Complete a good nutritional history.
- Monitor and trend albumin.
- Discuss avoiding caffeinated drinks, coffee, tea.
Clinical Judgement
- Consider how to decrease the fear of suffocation during this procedure.
Follow-Up and Desired Outcomes
- Acknowledges the value of avoiding foods or drinks that cause gastric upset (e.g., hot peppers, spicy curry, caffeine, alcohol).
- Agrees to follow therapeutic regime designed to treat specific diagnosis.