Endoscopic Procedures for Upper Gastrointestinal Tract Examination

Pre-Procedural Preparation

• The American Society for Gastrointestinal Endoscopy recommends obtaining informed consent and administering appropriate analgesia/sedation, such as midazolam IV, before the procedure 1
• Antibiotic prophylaxis is recommended before interventional EGD procedures, as suggested by the European Society of Gastrointestinal Endoscopy 2

Diagnostic and Therapeutic Purposes

• The American Association for the Study of Liver Diseases recommends screening for esophageal varices in cirrhosis using EGD, with follow-up intervals based on varice size and liver disease severity 3, 4
• The American Society for Gastrointestinal Endoscopy recommends EGD for diagnostic purposes, including evaluation of upper GI symptoms, dysphagia, and suspected upper GI bleeding 1
• The World Gastroenterology Organisation recommends EGD for therapeutic purposes, including foreign body removal, food bolus impaction management, and placement of feeding tubes (PEG) 5, 6, 1

Procedure-Specific Guidelines

• The European Society of Gastrointestinal Endoscopy recommends gently pushing the bolus into the stomach as first-line treatment for food bolus impaction, with retrieval using baskets, snares, or grasping forceps if pushing is unsuccessful 5, 6
• The American Society for Gastrointestinal Endoscopy recommends taking biopsies at index endoscopy to diagnose potential underlying conditions like eosinophilic esophagitis 6

Post-Procedural Care

• The American Society for Gastrointestinal Endoscopy recommends monitoring vital signs and observing for complications after the procedure, with patients able to resume oral intake after recovery from sedation 1
• The European Society of Gastrointestinal Endoscopy recommends delivering nutrients via the PEG tube 1 hour after uncomplicated placement 1

Special Considerations

• The American College of Gastroenterology recommends reserving EGD for urgent/emergent indications and considering alternative approaches, such as interventional radiology, for certain procedures in COVID-positive patients 7
• The European Society of Gastrointestinal Endoscopy recommends ERCP skills for EGD with advanced interventions, such as pseudocyst drainage, with proficiency typically requiring supervised training and performance of multiple procedures 2