An EGD is not actually a surgery. It stands for esophagogastroduodenoscopy, and it’s a diagnostic and therapeutic procedure where a gastroenterologist passes a thin, flexible scope through your mouth to examine the lining of your esophagus, stomach, and the first part of your small intestine (the duodenum). The whole thing typically takes 15 to 30 minutes, and you go home the same day.
Why Doctors Order an EGD
An EGD is one of the most common tools for investigating persistent upper digestive symptoms. If you’ve been dealing with heartburn, nausea, vomiting, abdominal pain, difficulty swallowing, or signs of gastrointestinal bleeding, this procedure lets your doctor see exactly what’s going on inside rather than guessing based on symptoms alone.
Beyond just looking, an EGD allows your doctor to take small tissue samples (biopsies) during the same visit. These samples can be tested for conditions causing anemia, chronic inflammation, diarrhea, or bleeding. It’s also one of the primary ways to detect cancers of the upper digestive tract and to identify precancerous changes like Barrett’s esophagus, a condition where the tissue lining the lower esophagus changes in a way that raises cancer risk. A special imaging mode called narrow band imaging uses filtered light to make these precancerous areas easier to spot.
An EGD isn’t always just diagnostic. Small tools can be passed through the scope to treat problems on the spot: cauterizing a bleeding vessel, stretching open a narrowed esophagus, clipping off a polyp, or pulling out a swallowed foreign object. Sometimes an ultrasound probe is attached to the scope to get images of deeper structures, including the pancreas, which is otherwise difficult to visualize.
Recent guidelines from the American Society for Gastrointestinal Endoscopy also recommend EGD as a screening tool for specific populations. For example, patients who’ve had sleeve gastrectomy (a type of weight-loss surgery) are now advised to have an endoscopic screening 3 years after the procedure and then every 5 years, even without symptoms.
How to Prepare
Preparation is straightforward but requires some planning ahead. You’ll need to stop eating solid food after midnight the night before, and you should have nothing to eat or drink for at least 8 hours before the procedure.
Certain medications need to be paused on a specific timeline:
- 7 days before: Stop taking iron supplements, aspirin, aspirin-containing products, and bismuth subsalicylate (Pepto Bismol).
- 5 days before: Stop nonsteroidal anti-inflammatory drugs like ibuprofen (Advil, Motrin), naproxen, and celecoxib (Celebrex).
- Day of: You can take your regular medications 4 hours before the procedure with small sips of water, but skip any antacids. Acetaminophen (Tylenol) is fine and doesn’t interfere with the procedure.
If you take blood thinners or medications you’ve been told never to stop abruptly, work that out with your prescribing doctor well in advance. These timelines can vary depending on your specific situation.
What Happens During the Procedure
You’ll receive sedation before the procedure begins, which means you’ll be drowsy or asleep and unlikely to remember much afterward. A mouth guard is placed between your teeth to protect them and keep your mouth open. The gastroenterologist then gently guides the endoscope, a flexible tube about the width of a finger with a camera and light on the end, through your mouth and down into your esophagus.
As the scope moves through your esophagus, stomach, and into the duodenum, the camera sends a live video feed to a monitor. Your doctor examines the tissue lining for redness, ulcers, masses, narrowing, or other abnormalities. Air is gently pumped through the scope to inflate the digestive tract slightly, giving a clearer view. If anything looks concerning, your doctor can take biopsies through the scope using tiny forceps, a process you won’t feel. Therapeutic interventions like polyp removal or dilation happen during this same pass.
For patients being evaluated for acid reflux (GERD), current guidelines call for thorough documentation of specific findings: the grade of any erosive damage to the esophagus, the size and type of any hiatal hernia, and whether Barrett’s esophagus is present, including its extent.
Recovery After the Procedure
After the scope is removed, you’ll spend 30 to 60 minutes in a recovery area while the sedation wears off. Your throat will likely feel mildly sore or scratchy, and you may feel bloated from the air that was introduced during the exam. Both of these resolve within a day, often within hours.
Because of the sedation, you won’t be able to drive yourself home. Plan to have someone with you. Most people are told to avoid operating machinery or making important decisions for the rest of the day. You can usually start with soft foods and clear liquids once the numbness in your throat fades and you can swallow comfortably, then return to your normal diet by the next day.
If biopsies were taken, results typically come back within a few days to a week. Your doctor will usually share any visual findings with you shortly after the procedure, though you may not fully remember the conversation due to lingering sedation effects, so having your companion present is helpful.
Risks and Complications
EGD is considered a very safe procedure. Serious complications are rare. The main risks are bleeding and perforation (a small tear in the digestive tract wall). For routine diagnostic EGDs, these occur in fewer than 1 in 1,000 procedures. The risk increases modestly when therapeutic work is done during the procedure, such as removing a large polyp, where bleeding rates can reach around 3% and perforation around 1.3%.
Other possible but uncommon issues include a reaction to the sedation, a sore throat lasting more than a couple of days, or a mild infection. Signs that something may be wrong after an EGD include fever, chest pain, worsening abdominal pain, difficulty swallowing that gets worse rather than better, or vomiting blood. These would warrant immediate medical attention, but the vast majority of people experience nothing more than mild throat discomfort and temporary bloating.