Upper Endoscopy (EGD): What to Expect

Why would a doctor order an upper endoscopy?

Upper endoscopy is used both to diagnose and to treat conditions of the upper digestive tract. Common reasons include:

• Investigating persistent heartburn or acid reflux that is not responding to treatment, or evaluating for Barrett’s esophagus — a precancerous change in the esophageal lining that is the only known precursor to esophageal adenocarcinoma 1Ref 1Katz PO, Dunbar KB, Schnoll-Sussman FH, Greer KB, Yadlapati R, Spechler SJ (2022).ACG Clinical Guideline: Guidelines for the Diagnosis and Management of Gastroesophageal Reflux Disease.Endoscopy as a diagnostic tool for evaluating GERD, Barrett’s esophagus, and treatment-refractory heartburn2Ref 2Shaheen NJ, Falk GW, Iyer PG, Souza RF, Yadlapati RH, Sauer BG, Wani S (2022).Diagnosis and Management of Barrett’s Esophagus: An Updated ACG Guideline.Barrett’s esophagus as the only known precursor to esophageal adenocarcinoma; upper endoscopy indications for screening and surveillance; biopsies to assess dysplasia grade
• Evaluating difficulty swallowing (dysphagia) or unexplained upper abdominal pain
• Finding the cause of gastrointestinal bleeding, including dark or tarry stools, or investigating iron-deficiency anemia
• Taking biopsies to test for *H. pylori* infection, celiac disease, or other conditions requiring tissue confirmation
• Removing polyps, treating bleeding ulcers, or dilating a narrowed esophagus during the same visit
• Assessing nausea, vomiting, or unexplained weight loss when a structural cause is suspected

Your gastroenterologist will explain the specific reason for your procedure at your consultation. The American Gastroenterological Association recommends that EGD exams be performed with a systematic approach to maximize detection of upper GI pathology 3Ref 3Nagula S, Parasa S, Laine L, Shah SC (2024).AGA Clinical Practice Update on High-Quality Upper Endoscopy: Expert Review.Best practice advice for a systematic, high-quality upper endoscopic exam including optimization of detection of upper GI pathology and evaluation of suspected premalignancy.

How do I prepare for an upper endoscopy?

Fasting: The most important preparation step is fasting. You will typically need to stop eating solid food for at least 6–8 hours before the procedure and stop clear liquids at least 2 hours before. Your doctor will give you specific written instructions. An empty stomach ensures the best view and reduces the risk of aspiration during sedation.

Medications: Tell your gastroenterologist about all medications you take, especially blood thinners (warfarin, clopidogrel, or newer anticoagulants), aspirin, and NSAIDs. Some may need to be temporarily stopped. Most routine medications taken with a small sip of water are usually fine to continue the morning of the procedure — your care team will clarify which apply to you.

Arrange a ride: Because IV sedation is used, you will not be allowed to drive yourself home. Arrange for a responsible adult to pick you up; most facilities will not proceed with sedation if you cannot confirm this.

What happens during the procedure?

When you arrive, a nurse will place an IV line and review your medical history and allergies. You will then receive IV sedation — most commonly a combination of a benzodiazepine (typically midazolam) and an opioid analgesic (typically fentanyl) 4Ref 4ASGE Standards of Practice Committee; Early DS, Lightdale JR, Vargo JJ 2nd, et al. (2018).Guidelines for sedation and anesthesia in GI endoscopy.IV sedation regimen (opioid + benzodiazepine) for upper endoscopy; monitoring requirements (blood pressure, oxygen saturation, heart rate); midazolam and fentanyl as standard agents. This moderate sedation brings on a drowsy, relaxed state; most people have little or no memory of the procedure. In some settings, propofol may be used for deeper sedation, administered by an anesthesia professional.

Your throat may be numbed with a topical spray to reduce the gag reflex. You will be positioned on your left side, and a small plastic bite guard will be placed between your teeth to protect them and the scope.

The gastroenterologist gently passes the endoscope — a thin, flexible tube roughly the diameter of a finger — through your mouth, into the esophagus, stomach, and duodenum. The procedure itself typically takes 10–20 minutes. If biopsies, polyp removal, or other interventions are needed, it may take slightly longer.

You will not feel pain during a well-sedated procedure, though some people are briefly aware of mild pressure.

What should I expect in recovery?

After the procedure, you will rest in a recovery area for 30–60 minutes while the sedation wears off. Common experiences during recovery include:

• Bloating or gas — air introduced during the procedure for better visibility; this typically passes within 1–2 hours
• Mild sore throat — usually resolves within 24 hours; ice chips or throat lozenges can help
• Grogginess — sedation can make you feel drowsy and foggy for the rest of the day; avoid making important decisions or signing legal documents that day

Most people can drink clear liquids within an hour of recovery and eat lightly later in the day. If biopsies were taken, your doctor may recommend avoiding hot liquids or rough foods for the first 24 hours.

How safe is an upper endoscopy?

EGD is considered a safe procedure with a low rate of serious complications. According to an ASGE review, serious adverse events including perforation, significant bleeding, and aspiration occur in fewer than 1 in 1,000 diagnostic procedures 5Ref 5ASGE Standards of Practice Committee; Coelho-Prabhu N, Forbes N, Thosani NC, et al. (2022).Adverse events associated with EGD and EGD-related techniques.Rates and predictors of adverse events (perforation, bleeding, aspiration) in diagnostic and therapeutic upper endoscopy; perforation rate 1 in 2,500 to 1 in 11,000 for diagnostic EGD. Perforation rates in large registries range from approximately 1 in 2,500 to 1 in 11,000 cases for diagnostic EGD; rates are higher when therapeutic interventions such as dilation are performed.

Sedation-related complications are similarly uncommon when IV monitoring of blood pressure, oxygen saturation, and heart rate is maintained throughout the procedure, as recommended by ASGE guidelines 4Ref 4ASGE Standards of Practice Committee; Early DS, Lightdale JR, Vargo JJ 2nd, et al. (2018).Guidelines for sedation and anesthesia in GI endoscopy.IV sedation regimen (opioid + benzodiazepine) for upper endoscopy; monitoring requirements (blood pressure, oxygen saturation, heart rate); midazolam and fentanyl as standard agents.

Risk increases with certain patient factors (older age, significant medical comorbidities) and with therapeutic maneuvers. Your gastroenterologist will discuss your individual risk profile and obtain informed consent before proceeding.

When will I get my results?

The gastroenterologist can usually share what they observed visually — for example, visible inflammation, an ulcer, or a polyp — immediately after the procedure before you leave the facility. Biopsy results from the pathology laboratory typically take 5–7 business days. Your gastroenterologist or their office will contact you with those results and any recommended next steps.

Scheduling an upper endoscopy

Upper endoscopy is performed by gastroenterologists. If your primary care doctor has referred you for this procedure, Gale can help you organize your symptom timeline and current medication list to bring to your GI consultation.