Esophagogastroduodenoscopy (EGD), also known as an upper endoscopy, is a procedure that allows your doctor to examine your esophagus, stomach, and duodenum (part of your small intestine). Generally, an EGD is performed in patients with the following symptoms:

1. Digestive disorders that result in symptoms of aches, numbness, tightness, burning, or sharp pains in the upper abdomen, which are presumed to be caused by the stomach or small intestines, along with the following signs:
   • Persistent vomiting
   • Unexplained weight loss
   • Difficulty swallowing
   • Gastrointestinal bleeding, as evidenced by vomiting blood or dark black stool
   • No improvement in symptoms following treatment
   • In cases of extreme anxiety or at a patient’s request
2. Chronic acid reflux, a condition characterized by frequent heartburn, which may also be accompanied by acid regurgitation
3. Bleeding in the upper intestinal tract, which can cause vomiting of blood or stool that is dark and has a foul odor with the appearance of asphalt or caramel.
4. All patients with cirrhosis should have an endoscopy to look for enlarged veins in the esophagus

Precautions before undergoing the EGD procedure

• Fasting from both food and water for at least 6-8 hours
• If taking medications regularly for chronic disease, consult your doctor whether this medication should be stopped
• Always bring along a relative or friend, because in some cases you may be given medication that causes drowsiness

Overview of the EGD procedure

• First, you will receive local anesthesia in the back of your throat, which will be injected about 3 times, each 5 minutes apart. After anesthetization, you will feel numbness at the base of your tongue and have difficulty swallowing. These symptoms will disappear within 1-2 hours after the procedure.
• The staff will position you for the procedure, which requires you to lay on your left side, similar to hugging a body pillow.
• The endoscopy usually takes about 5-10 minutes. During the procedure, you may feel discomfort in your abdomen, which is caused by the air being blown in to expand your stomach. This sensation is normal.
• After the procedure, you can eat once your gag reflex has returned and you don’t have any difficulty swallowing. It is advisable to try drinking cold water first to ensure swallowing is not difficult before trying to eat. Hot beverages should not be consumed at first, because this can be dangerous following the use of local anesthesia.
• After the procedure, you can continue with your normal daily routine.

Possible complications from EGD

• In some cases, abdominal bloating and flatulence may be felt after the EGD, which is caused by the air blown in to expand the stomach during the procedure.
• Damage to the throat, esophagus, stomach, or upper intestines may occur as a result of perforation. However, this is very rare and occurs in only 0.03% of cases. This almost always requires emergency surgery to repair the damage.
• The possibility of choking and aspiration of food, saliva, or stomach acid that results in pneumonia.
• Possible abnormal bleeding following biopsy

Colonoscopy: An endoscopy of the entire large intestine is performed, along with a portion of the small intestines. Those who would benefit from a colonoscopy include:

• Those with digestive disorders, such as chronic constipation, chronic diarrhea (more than 4 weeks), bloody stool, or the constant feeling of needing to pass stool (tenesmus)
• Those that observe bleeding while passing stool
• Those with chronic abdominal pain with unknown cause
• Those with relatives that have had colorectal cancer
• Anyone aged 50 years or older, in order to screen for colorectal cancer

Preparing for a colonoscopy

• Three days before your colonoscopy, eat low-fiber foods that are easy to digest, such as rice porridge or white bread. Don’t eat fatty foods or foods high in fiber, such as raw vegetables or fruit with seeds.
• Don’t eat or drink anything after midnight the night before the procedure.
• Your doctor will advise you to take a laxative the day before your colonoscopy to clean out your colon. You should strictly follow the doctor’s orders. Otherwise, if the colon is not clean, the colonoscopy will not be possible.
• If you have any chronic diseases or regularly take any medication, you should consult your doctor about whether the medications should be stopped before the procedure.
• Please have a friend or relative accompany you on the day of the procedure. Some pain medications may be administered, which may cause you to feel drowsy.
• You will be able to return home and resume normal activities after the procedure. However, if you observe any abnormal symptoms, such as bloody stools, contact your doctor.
• If you have any questions, you can ask your doctor or any of our staff for more information.

Possible complications from a colonoscopy

• Some abdominal discomfort is possible after the colonoscopy, which is caused by the air blown to expand the colon during the colonoscopy. Symptoms will gradually improve.
• In rare cases, the colon may be perforated during the procedure. This occurs in approximately 0.5-1% of cases and may require emergency surgery.
• Bleeding may occur in about 1-2% of cases. This usually occurs in cases that required biopsy.
• Some patients may experience an allergic reaction to pain medicine given during the colonoscopy. In such cases, patients may experience fainting, chest tightness, shortness of breath, a slowed heartrate, or low blood pressure.

Hepatitis

Symptoms of cirrhosis

The symptoms of cirrhosis will depend on the progression of the disease. The most common symptoms include:

• Yellow eyes, yellow skin, dark urine (jaundice)
• Weight loss
• Darkening of the skin (hyperpigmentation)
• Enlarged or fluid-filled abdomen (ascites)
• Swollen cheeks as a result of swelling in salivary glands (parotid gland enlargement)
• In men, there may be shrunken testicles (testicular atrophy) or enlarged breasts (gynecomastia)
• Enlarged liver and spleen (hepatosplenomegaly)
• Redness in the palms of the hands (palma erythema)
• Swelling, spider-like veins around the belly button (caput medusae) potentially accompanied by a hum that can be heard with a stethoscope (Cruveilhier-Baumgarten murmur)

Complications

Potential complications of cirrhosis include:

• Enlarged or fluid-filled abdomen (ascites)
• Infection in the abdomen (spontaneous bacterial peritonitis)
• Bleeding from the veins in the esophagus and stomach (variceal hemorrhage)
• Impaired kidney function (hepatorenal syndrome)
• Liver cancer

Living with Cirrhosis

Guidelines for living with cirrhosis:

• Educate yourself about the disease. Patients with cirrhosis can live a normal life.
• Maintain good personal hygiene
• Maintain a healthy diet, consisting of the following recommended foods:
  • Protein. The recommended sources of protein are from fish, chicken, lean pork, and plants such as soybeans or other legumes (e.g., peas). Patients with cirrhosis tend to eat less for different reasons, such as reduced appetite, which can result in nutrient deficiency. If dietary intake is insufficient, the body will use protein as an energy source, resulting in protein deficiency.
  • Carbohydrates. The recommended source of carbohydrates is from whole-grain rice and bread, with sufficient amounts to provide energy to the body.
  • Fats. Foods should be cooked with appropriate oils high in unsaturated fat, such sunflower oil or canola oil.
  • Vitamins. Vitamins come from clean fruits and vegetables. Some vitamins, such as vitamin D or calcium, are given as supplements but only to those who have a history of or are otherwise at high risk of osteoporosis, such as smokers, as well as to those with a history of bone fractures.

Guidance for cirrhosis patients

In cases of severe liver cirrhosis that results in fluid-filled abdomen (ascites), leg swelling, and/or edema, it is important to eat enough protein, equivalent to the egg whites of 6-10 eggs per day, in order to increase protein in the blood and reduce water in the stomach. With sufficient protein intake, swelling symptoms will improve and also improve overall survival rate.

• The following foods should be avoided:
  • Any salty foods, such as salted eggs or salted fish, because they will cause more leg swelling
  • Fermented foods and intensely flavored foods
  • Raw, uncooked, or inadequately prepared foods
  • Seafood, such as clams, because they contain pathogens that are dangerous to cirrhosis patients.
• Abstain from all alcohol. Any kind of moonshine is strictly prohibited.
• Abstain from local dietary supplements.
• Abstain from any local medicine, herbal medicines, or any other medicine not prescribed by a physician
• Refrain from eating mushrooms. Some types can be toxic to the liver, especially wild mushrooms.
• Exercise normally, within the limits of fatigue or exhaustion.
• Undergo regular ultrasounds and liver cancer screenings every 6 months. Take the medicine, as prescribed by the doctor.