An upper endoscopy is an exam of the upper part of your digestive tract: the esophagus (the tube that carries food from your mouth to your stomach), the stomach, and the duodenum (the first part of the small intestine). Doctors also call it an EGD, short for esophagogastroduodenoscopy. If you live in Los Angeles and your doctor has suggested one, here is what to expect.
Why do people have an upper endoscopy?
An EGD uses a thin, flexible tube with a small camera on the end, called an endoscope. It passes through your mouth, so there are no cuts. It gives Dr. Pimienta a direct, clear view of the lining, which an X-ray or scan cannot do as well. Common reasons include:
- Heartburn or acid reflux that does not settle with medicine, or that has lasted for years (see acid reflux and GERD)
- Trouble swallowing, or a feeling that food sticks in your chest (see swallowing difficulties)
- Pain or burning in the upper abdomen that keeps coming back
- Nausea or vomiting that does not have a clear cause
- Signs of bleeding, such as black stools, or iron-deficiency anemia (low red blood cells from low iron)
- Barrett's esophagus surveillance: Barrett's esophagus is a change in the lining of the esophagus caused by long-term reflux. It slightly raises the chance of cancer, so people who have it usually need EGDs from time to time.
- Testing for celiac disease: small biopsies of the duodenum can confirm celiac disease, a reaction to gluten that damages the small intestine.
- Testing for H. pylori: a common stomach infection that can cause ulcers and inflammation. Biopsies of the stomach can find it.
Not everyone with heartburn or stomach pain needs an EGD. Dr. Pimienta looks at your symptoms, your age, your medicines and your risk factors to decide whether an exam will help. Your plan depends on your health; Dr. Pimienta will talk with you about what fits you.
Key facts
- The exam itself
- Usually about 15 to 30 minutes
- Prep
- An empty stomach; no bowel prep for an EGD alone
- Sedation
- Medicine through an IV so you are relaxed or asleep
- Ride home
- You need an adult to take you home
- Afterward
- A mild sore throat for a day or so is common
How do I prepare for an upper endoscopy?
Your stomach needs to be empty so Dr. Pimienta can see clearly and so the exam is safe under sedation. Your written instructions from our office will give exact times. In general:
- Food: nothing to eat for several hours before the exam, usually starting the night before.
- Liquids: clear liquids may be allowed until a set time before your arrival, then nothing by mouth.
- Medicines: tell us about every medicine you take, especially blood thinners, insulin and other diabetes medicines. Ask which ones to take the morning of the exam with a small sip of water.
- A ride home: arrange for an adult to take you home.
Taking a GLP-1 medicine? Medicines such as semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro, Zepbound) slow how fast the stomach empties. Food can stay in the stomach longer than usual, which matters during sedation. Please tell our office when you schedule. Do not stop these medicines on your own; Dr. Pimienta will give you specific instructions.
The procedure preparation guide covers medicines, what to bring and what to wear in more detail.
What happens during an upper endoscopy?
Dr. Pimienta performs upper endoscopy at Specialty Surgical Center of Beverly Hills, on Wilshire Boulevard less than a mile west of the office.
Check-in
Staff confirm your identity, your medicines, when you last ate and drank, and who is driving you home. You change into a gown and a small IV is placed in your hand or arm.
Sedation
You lie on your left side. A small mouth guard protects your teeth and the scope. Medicine through the IV makes you relaxed and sleepy, and most people do not remember the exam. Your breathing, heart rate, blood pressure and oxygen are watched the whole time.
The exam
Dr. Pimienta passes the endoscope through your mouth, down the esophagus, into the stomach and on to the duodenum. A little air opens the space so he can see the lining. The scope does not block your breathing.
Biopsies if needed
If an area needs a closer look, he takes tiny samples of tissue with small forceps passed through the scope. This does not hurt.
Recovery
You wake up in the recovery area, usually within minutes. Once you are alert, you hear what was seen and get written instructions, and your ride takes you home.
What can biopsies show?
A biopsy is a tiny piece of the lining, about the size of a grain of rice. A pathologist (a doctor who studies tissue) looks at it under a microscope. Biopsies during an EGD can show inflammation, H. pylori infection, celiac disease, Barrett's esophagus, eosinophilic esophagitis (an allergy-type inflammation that can make swallowing hard) and, rarely, cancer or precancerous changes. Taking a biopsy does not mean Dr. Pimienta suspects cancer; biopsies are a routine part of many exams.
Biopsy results usually come back within about one to two weeks. Dr. Pimienta goes over them with you and explains what they mean for your treatment.
What happens after an upper endoscopy?
Plan to rest for the rest of the day. Do not drive, work, sign important papers, or drink alcohol until the next day. Common, normal effects include:
- A mild sore throat for a day or so. Throat lozenges or cool drinks can help.
- Some bloating or burping from the air used during the exam.
Most people can eat once the sedation wears off. Start with something light. Most people are back to their usual activities the next day.
Can I have an EGD and a colonoscopy the same day?
Yes. If you need both, they can usually be done one right after the other under the same sedation. The EGD is usually done first. You follow the full colonoscopy bowel prep, and you only need one ride and one recovery.
Is an upper endoscopy safe?
Upper endoscopy is a common and generally safe procedure. Serious problems are uncommon. Possible risks include bleeding (more likely after a biopsy, and usually minor), a tear (perforation) in the lining, which is rare, and reactions to the sedation, such as changes in breathing or blood pressure. Dr. Pimienta reviews the risks with you before the exam.
Call 911 or go to the nearest emergency room if after your EGD you have severe chest, neck or belly pain, trouble breathing, fever, vomiting blood or material that looks like coffee grounds, black stools, or trouble swallowing that is getting worse. If food ever gets stuck and you cannot swallow your saliva, that is an emergency too.
Questions patients ask
Will I be able to breathe during the exam?
Yes. The endoscope goes down the esophagus, not the windpipe, so it does not block your breathing. Your oxygen level is checked throughout.
Will I gag?
Most people are asleep or very relaxed from the sedation and do not notice gagging. Many people do not remember the exam at all.
Do I need a bowel prep for an EGD?
No, not for an EGD alone. You only need an empty stomach. If you are having a colonoscopy the same day, you follow the colonoscopy bowel prep.
Should I keep taking my acid medicine before the exam?
Ask our office. In some cases, such as testing for H. pylori, Dr. Pimienta may ask you to pause certain medicines beforehand. Do not stop any medicine unless we tell you to.
How soon will I know the results?
You usually hear what Dr. Pimienta saw before you leave. Biopsy results usually take about one to two weeks, and he goes over them with you.
I have celiac disease symptoms. Should I stop eating gluten before testing?
Not before you talk with us. Celiac tests, including biopsies, are most accurate while you are still eating gluten. Going gluten-free first can hide the diagnosis.