General

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.

Critical Findings and Potential Interventions

• Presence and location of acute gastrointestinal (GI) bleed

Timely notification to the requesting health-care provider (HCP) of any critical findings and related symptoms is a role expectation of the professional nurse. A listing of these findings varies among facilities.