Esophagogastroduodenoscopy (EGD) is an endoscopic examination used to diagnose gastric diseases. EGD is recommended for patients with alarm symptoms like weight loss, bleeding, or recurrent vomiting. It is also used for screening and surveillance of conditions like Barrett's esophagus or gastric cancer. EGD allows visualization of the esophagus, stomach, and duodenum and collection of biopsy samples. Potential complications include those related to sedation as well as bleeding and perforation. Radiologic tests like barium X-rays or CT scans can also image the stomach and identify abnormalities. Endoscopic ultrasound and gastric secretory analysis provide additional diagnostic information. Tests for Helicobacter pylori infection are

1. Diagnostic modalities
for Gastric diseases
Pushpa Lal Bhadel

2. Esophagogastroduodenoscopy
Alarm symptoms
 Weight loss
 Recurrent vomiting
 Dysphagia
 Bleeding
 Anemia

3. Diagnostic examination
•Upper abdominal symptoms that fulfill any of the following criteria:
Are unresponsive to empiric therapy
•Are associated with alarm symptoms
•New-onset symptoms in a patient greater than 50 years of age
Dysphagia
Odynophagia
Persistent or recurrent esophageal reflux despite therapy
Persistent vomiting of unknown cause
Active or recent upper GI bleeding
•Presumed chronic blood loss and iron deficiency anemia if any of the following are present:
There is clinical suspicion of an upper GI source
•Colonoscopy is negative
Lesion seen on upper GI tract imaging
Acute caustic ingestion
When sampling of tissue or fluid is indicated
Evaluation of diarrhea in a patient suspected of having small bowel disease (eg, celiac disease)
Intraoperative evaluation of anatomic reconstructions

4. Screening/surveillance
Dysplasia surveillance in patients with Barrett's esophagus
Gastric cancer screening in selected patients*
Screening for upper GI malignancies in patients with polyposis syndromes or Lynch syndrome
Screening for esophageal varices in patients with portal hypertension
Screening for squamous cell carcinoma in patients with a history of caustic ingestions
Examination to identify upper GI pathology that might influence the treatment of other disorders
(eg, evaluating a patient with a history of upper GI bleeding prior to initiating anticoagulation)

5. Complications
 Related to sedation
 Methemoglobinemia
 Bleeding
 Perforation
 Infection

6. The light pink mucosa (yellow arrow) represents the squamous lining of the
esophagus, whereas the salmon-colored mucosa (white arrow) represents the
columnar gastric mucosa. The squamocolumnar junction is also known as the "z-line."

7. Gastric folds seen upon passage of an upper endoscope
into the stomach during esophagogastroduodenoscopy

8. Gastric folds seen upon passage of an upper
endoscope into the stomach during
esophagogastroduodenoscopy
Retroflexion of endoscope within the stomach
Retroflexion of the endoscope permits
visualization of portions of the stomach that
are not well seen during forward-viewing with
the endoscope

9. Retroflexed view of the
esophagogastric junction and the
proximal stomach
Hiatus hernia

10. Endoscopic views of the antrum (left) and pylorus (right).

11. Peptic ulcer (yellow area surrounded by red
contour) above the pylorus (star)
Fresh ulcer in the duodenal bulb with erosion
of a vessel.

12. Radiologic tests
X-ray
Free gas under domes present. Hiatus
hernia is present.

13. Left lateral decubitus shoot through

14. A large amount of gas is seen under both
diaphragmatic domes (yellow dotted lines). In
the left upper quadrant gas is also seen in the
stomach (red dotted line) and splenic flexure
of the colon (blue dotted line).
Chest x-ray shows air under the
diaphragmatic domes. No additional findings
on the radiograph.

15. Barium meal
Irregular stenosis with rigidity of the
greater curvature of the stomach at
prepyloric gastric antrum.

16. Air filled fundus
Barium filled antrum
Duodenal bulb
Narrowed pyloric channel
Barium meal single contrast shows Narrowed pyloric
channel With distended stomach no mucosal destruction

17. Gastric Outlet Obstruction

18. Double contrast barium meal
 A modified form of barium meal examination
 A small quantity of barium and introducing gas
into the stomach
 Produce double contrast mucosal films of the
whole of the stomach.

19. Double contrast shows localizes collection of
barium in ulcer crater with smooth thickened
mucosal folds reaching ulcer edge

20. A round, sharply contoured
filling defect was identified,
situated on the lesser
curvature of the stomach, near
the angular incisure,
approximately 2.5 cm in
diameter.

21.  Endoscopy more sensitive (92% versus
54%, p < 0.001) and specific (100% versus
91%, p < 0.05) than the double-contrast
barium meal

22. Gastric trichobezoar

23. Gastric polyp

24. Computed tomography scanning

25. CT-scan phase with oral contrast (without IV contrast) shows a voluminous subtraction image
at the region of the fundus, compatible with an intra-luminal mass. This mass is hypodense
and heteregeneous

26. A, Conventional double-contrast barium
study shows two pedunculated polyps
(arrows) arising from gastric mucosa of
lesser curvature.
B, Ray sum (anterosuperior view) three-
dimensional
C and D, Conventional endoscopic
images
show polyps. Polyp on oral side (arrow,
Dl
is lobulated.
E and F Virtual endoscopic images also
show polyps and superficial lobulation
(arrow, F).

27. Magnetic Resonance Imaging

28. Endoscopic Ultrasound

29. Gastric Secretory Analysis
 Evaluation of patients in with
hypergastrinemia, Zollinger-Ellison syndrome,
refractory ulcers, GERD, recurrent ulcers after
operation
 Pancreatic polypeptide
 Normal basal acid output(BAO): 5mEq/h
 Maximal acid output(MAO): 10-15mEq/h

30. Scintigraphy
 Ingestion of test meal with one or two
isotopes
 Scanning patient under gamma camera
 Curve is plotted and half-time calculated

32. Tests for Helicobacter pylori
Endoscopic testing
 Biopsy urease testing
 Histology
 Bacterial culture and sensitivity testing
Non-invasive testing
 Urease breath test
 Stool antigen assay
 serology

34. Antroduodenal Motility testing
Electrogastropgaphy

35. Reference
• Sabiston textbook of Surgery, 1st South Asia
edition
• Schwartz’s principles of surgery, 10th edition
• www.uptodate.com

36. Thank You