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Esophagogastroduodenoscopy (EGD) is a cornerstone diagnostic and therapeutic procedure in modern gastroenterology, allowing direct visualization of the upper gastrointestinal tract, including the esophagus, stomach, and duodenum, with extended reach into the distal duodenum and jejunum when indicated. This course reviews the role of EGD in evaluating symptoms such as dysphagia, upper gastrointestinal bleeding, refractory gastroesophageal reflux disease, unexplained anemia, and malabsorption, while also enabling therapeutic interventions, including hemostasis, stricture dilation, variceal ligation, tissue sampling, and foreign body removal. Technological advances and established quality indicators from professional societiesare also discussed. This activity outlines EGD indications, anatomy, technique, contraindications, complications, and quality standards. Participants will also gain insight into patient selection, procedural execution, risk mitigation, tissue sampling strategies, and adherence to guideline-driven quality measures. This activity for healthcare professionals is designed to enhance the learner's competence in the safe performance of EGD and in implementing an appropriate interprofessional approach when employing this procedure, thereby enhancing clinical decision-making, procedural competence, and patient outcomes across adult and pediatric populations. Objectives: Identify the appropriate indications for esophagogastroduodenoscopy across various populations. Apply standardized procedural techniques to effectively evaluate upper gastrointestinal structures. Select evidence-based tissue sampling strategies for suspected gastrointestinal pathology. Apply effective interprofessional team strategies to improve care coordination and outcomes in patients undergoing esophagogastroduodenoscopy. Access free multiple choice questions on this topic.

Esophagogastroduodenoscopy (EGD) is a widely utilized diagnostic and therapeutic procedure that enables limited visualization of the oropharynx and detailed examination of the esophagus, stomach, and duodenum. When a longer instrument is used, the distal duodenum and jejunum can also be examined. This procedure plays a central role in the diagnostic evaluation of a wide variety of upper gastrointestinal disorders. In addition to its diagnostic utility, EGD facilitates therapeutic interventions, eg, hemostasis, stricture dilation, variceal ligation, and foreign body removal, making this modality an indispensable tool in modern gastroenterology. EGD is generally very safe, with major complications occurring in fewer than 2% of cases, although risks such as bleeding, perforation, or sedation-related cardiopulmonary events must be considered. Advances in technology, including high-definition scopes, optical zoom, and single-use disposable gastroscopes, have further enhanced diagnostic accuracy and infection control. Professional guidelines, including those from the American Society for Gastrointestinal Endoscopy (ASGE) and European Society of Gastrointestinal Endoscopy (ESGE), have emphasized the importance of quality indicators, documentation, and biopsy protocols to standardize practice and improve outcomes. As applications of EGD expand across both adult and pediatric populations, continued adherence to evidence-based protocols and interprofessional collaboration remain essential to maximizing the clinical impact of this versatile procedure.

Complications following EGD are rare, occurring in less than 2% of patients. These could be related to sedation, the endoscopy itself, or complications arising from diagnostic or therapeutic maneuvers. Sedation-Related Complications The most frequent and severe complications of sedation are cardiopulmonary; these account for as much as 60% of EGD-related adverse events.[25] These events include hypoxemia, hypoventilation, hypotension, airway obstruction, arrhythmias, and aspiration.[26] Procedure-Related Complications The complications following diagnostic EGD include bleeding, perforation, duodenal hematoma, and infection. The risk of bleeding following EGD with biopsy is 0.3%. Bleeding presents with hematemesis or bloody output from the gastrostomy tube. Bleeding following mucosal biopsy can occur as intraluminal hemorrhage or intraluminal hematoma. Duodenal hematoma is an uncommon complication, typically occurring after mucosal biopsies. Bowel perforation occurs in fewer than 0.3% of cases, and infection is rarely reported. Complications are typically identified within the first 24 hours after the procedure. Perforation is suspected in patients with fever, tachycardia, abdominal pain, or discomfort. An abdominal x-ray should be done to reveal extraluminal air. Conservative therapy with bowel rest and antibiotics is the typical treatment, although some patients might require surgical repair. With ongoing advancement in third-space endoscopy, the risk of adverse events, particularly that of bleeding and perforation, is elevated.[27][28]

In the context of EGD, an interprofessional team approach is essential to optimize patient-centered care, safety, efficiency, cleanliness of the working area, outcomes, and overall team performance. Physicians, particularly gastroenterologists or surgeons performing the procedure, must demonstrate technical proficiency in scope handling, mucosal inspection, recognition of pathology, and therapeutic interventions, while ensuring adherence to evidence-based quality measures, such as those outlined by the ASGE. Advanced practitioners, including nurse practitioners and physician assistants, play a vital role in preprocedure and postprocedure evaluations, patient education, and follow-up care, helping to streamline care and address patient concerns effectively. Nurses and endoscopic assistants (technicians) are central to procedural safety through patient preparation, sedation monitoring, and recovery care, and their roles frequently overlap. Their roles include preparing the endoscopy room and equipment, assisting with the management of endoscopes and accessories during procedures, monitoring vital signs (if an anesthesia professional is not present), collecting and managing tissue and fluid specimens, and instrument sterilization. Their role in recognizing early signs of complications and ensuring sterile technique directly impacts patient outcomes. Pharmacists contribute by managing sedation protocols, assessing drug interactions, and advising on periprocedural medication adjustments, especially in patients on antithrombotics or other high-risk medications. Clear communication among team members regarding indications, findings, complications, and follow-up care promotes patient-centered management, minimizes procedural risk, and strengthens overall team performance and quality of care.