Top 10 tips for performing a high-quality upper endoscopy (with videos)

Abstract

When performed appropriately and safely, esophagogastroduodenoscopy (EGD) is an invaluable tool for diagnosing and monitoring a range of upper gastrointestinal disorders and cancers. With more than 6 million EGDs being performed in the United States and reports of missed upper GI (UGI) lesions, both experienced and budding endoscopists should keep a number of essential considerations in mind when performing an EGD, and that starts with obtaining a thorough patient medical history and ensuring that informed consent has been obtained. The right approach, including good posture, appropriate intubation, and proper use of torque, as well as slow endoscope insertion and withdrawal, helps make for a smooth and effective procedure. A clean mucosa, achieved using water and de-foaming and mucolytic agents, ensures clear visibility. Meticulous inspection of the mucosa will allow the endoscopist to detect all lesions and abnormalities. Adherence to established and indication-specific biopsy protocols and use of validated classification criteria should help histopathologists confirm a diagnosis. Maintaining vigilance after an endoscopy and informing our patients of symptoms and signs of procedure-related adverse events is essential for the early recognition and management of these possible adverse events. Finally, an evidence-based schedule of follow-up endoscopy built on endoscopic and histologic findings and risk factors for disease progression will help avoid overutilization of endoscopies.