ESOPHAGOGASTRODUODENOSCOPY/ESOPHAGOGASTROSCOPY – Purpose, Client Problems, Client Preparation, Procedure and Post-Procedural Care
Esophagogastroscopy includes gastroscopy and esophagoscopy. If duodenoscopy is included with the endoscopic examination, the term is esophagogastroduodenoscopy. A flexible fiberoptic endoscope is used for direct visualization of the internal structures of the esophagus, stomach and duodenum. Biopsy forceps or a cytology brush can also be inserted through a channel of the endoscope. Suction can be applied for the removal of secretions and foreign bodies
This test is performed under local anesthesia or IV sedation (benzodiazepine or narcotics), in a gastroenterologist. This procedure can be done on an emergency basis for removal of foreign objects (a bone, a pin, etc) and for diagnostic purposes. The major complications that can occur from esophagogastroduodenoscopy are perforation and hemorrhage
PURPOSE
- To visualize the internal esophagus, stomach, and duodenum
- To obtain a cytological specimen
- To confirm the presence of gastrointestinal pathology
CLINICAL PROBLEMS
- Esophageal
Description: esophagitis, hiatal hernia, esophageal stenosis, achalasia, esophageal neoplasm (benign or malignant tumors), esophageal varices, Mallory-Weiss tear
- Gastric
Description: gastritis, gastric neoplasm (benign or malignant), gastric ulcer (acute or chronic), gastric varices
- Duodenal (small intestinal)
Description: duodenitis, diverticula, duodenal ulcers, neoplasm (benign or malignant)
CLIENT PREPARATION
- Recognize that a gastroscopy for visualizing the esophageal, gastric and duodenal mucosa is actually an esophagogastroduodenoscopy. These names are frequently used interchangeably
- Explain the procedure to the client. Inform the client that instrument is flexible; the procedure will be done under local anesthesia (the throat will be sprayed) premedications will be given before the test and usually IV sedation is given with the test; dentures are jewelry should be removed; and food and fluids will be restricted for 8-12 hours before the test
- Check the client dentures, eyeglasses and jewelry is removed. Give a client a hospital gown
- Have the client void. Take vital signs
- Check the consent form has been signed before giving the client premedications. Once the sedative and the narcotic analgesic are given, the client should remain in bed with side up. Tell him or her that these medications will cause drowsiness
- Explain to the client that he or she may feel some pressure with the insertion of the endoscope and may feel some fullness in the stomach and intestine areas
- Be a good listener. Allow the client, time to ask questions and to express concerns or fear
PROCEDURE
- A consent should be signed
- The client should be on and NPO for 8-12 hours before the test. When this procedure is used during an emergency and NPO cannot be enforced, the client’s stomach is lavaged (suctioned) to prevent aspiration.
- The client may take prescribed medications at 6 am on the day of the rest. Check with laboratory or healthcare provider for any changes.
- A sedative/tranquilizer, a narcotic analgesic, and atropine may be given an hour before the test, or they can be titrated intravenously immediately prior to the procedure and during the procedure as needed
- A local anesthetic may be used
- Dentures, jewelry and clothing should be removed from the neck to the wrist
- Record baseline vital signs. The client should void before the procedure
- Specimen containers should be labeled with the client’s name, the date and the type of tissues
- Emergency drugs and equipment should be available for hypersensitivity to medications (premedication and anesthetic) and for severe laryngospasms
- The test takes approximately 1 hour or less
- The client should not drive self-home following the test because of possible after-effects of sedation
POST-PROCEDURAL CARE
- Check the gag reflexes offering food and fluids by asking the client to swallow or by touching the posterior pharynx with a cotton swab or tongue blade if the throat was sprayed with the anesthetic
- Monitor vital signs (blood pressure, pulse, respiration) as ordered
- Give the client throat lozenges or analgesics for throat discomfort. Inform the client that he or she may have flatus or burp-up gas, which is normal. This is caused by instillation of air during the procedure for visualization purposes
- Observe the client for possible complications
- Be supportive of the client and family
Complications: perforation in the gastrointestinal tract from the endoscope. Symptoms could include pain (epigastric, abdominal and back pain), dyspnea, fever, tachycardia and subcutaneous emphysema in the neck
Factors affecting diagnostic results: barium from a recent gastrointestinal images series can decrease visualization of the mucosa. This test should not be performed within 2 days after such tests. An X-ray film of the abdomen can be taken to see if barium is in the stomach or duodenum.
