ASGE Annual GI Advanced Practice Provider Course (On-demand) (Day One)

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This document is a teaching overview of <strong>upper GI endoscopy</strong> (upper endoscopy) by John A. Martin, MD, focused on definitions, indications, procedural components, documentation, and follow-up. “Upper GI endoscopy” is defined broadly as <strong>any endoscopic evaluation of the upper GI tract (esophagus, stomach, duodenum)</strong> performed via a <strong>natural orifice</strong>—typically the <strong>mouth</strong>, but sometimes the <strong>nares</strong>. The term encompasses multiple procedures beyond standard EGD, including <strong>esophagoscopy, esophagogastroscopy/EGD, push enteroscopy, and balloon enteroscopy</strong>, and may also involve advanced/interventional techniques (e.g., ERCP/EUS-related endoscopy, endoluminal Barrett’s and GERD therapies, third-space endoscopy, stenting/anastomoses, bariatric endoscopy).

A central theme is that endoscopy is <strong>not a stand-alone test</strong>; its value and safety depend on integrating it into overall disease management and communicating clearly with the patient and care team across all phases: <strong>consultation, pre-procedure preparation, the procedure, and post-procedure care</strong>, plus thorough documentation and photodocumentation.

<strong>Diagnostic indications</strong> include GERD; <strong>esophageal dysphagia/odynophagia</strong>; upper abdominal discomfort/bloating/dyspepsia; evaluation for celiac disease; abnormal imaging; GI bleeding or iron deficiency anemia; unexplained diarrhea; and selected screening/surveillance (e.g., <strong>varices</strong>, <strong>Barrett’s esophagus</strong>, polyposis/cancer syndromes, gastric intestinal metaplasia, post-resection surveillance). <strong>Therapeutic indications</strong> include hemostasis (non-variceal/variceal), dilation of strictures, ablation/resection of neoplasia/Barrett’s, endoluminal therapies for motility disorders, stenting, feeding tube placement, and bariatric therapies.

Pre-procedure priorities include confirming the <strong>appropriateness/urgency</strong>, assessing contraindications and anatomy/medical issues, obtaining <strong>informed consent</strong> (as a process), choosing sedation level, ensuring NPO status, and managing medications (especially <strong>antithrombotics</strong> and glycemic control). Risks are generally low in diagnostic EGD but include cardiopulmonary events, bleeding, perforation, infection, and rare mortality; therapeutic procedures carry higher risk. <strong>Antibiotic prophylaxis</strong> is usually unnecessary, but is recommended for <strong>cirrhotics with active GI bleeding</strong> and for <strong>PEG placement</strong>. Post-procedure care emphasizes recovery assessment, review of findings, discharge instructions, medication/antithrombotic restart guidance, and vigilance for delayed adverse events.

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John A. Martin, MD, FASGE

Keywords

upper GI endoscopy

esophagogastroduodenoscopy (EGD)

esophagoscopy

push enteroscopy

balloon enteroscopy

Barrett’s esophagus surveillance

GI bleeding hemostasis

informed consent and pre-procedure preparation

sedation and NPO management

antithrombotic medication management