Upper gastrointestinal endoscopy

Endoscopy is a procedure that allows a doctor to directly view the inside of a body organ or cavity with the use of an endoscope, a thin, flexible tube equipped with a camera lens and light. The flexibility of the tube allows the doctor to maneuver around multiple bends. Because the endoscope is hollow, various tools can be used to aid in diagnosis or treatment.

An upper endoscopy, often referred to as an upper gastrointestinal (GI) endoscopy or esophagogastroduodenoscopy (EGD), specifically allows the doctor to examine the lining of the gastrointestinal tract, including the esophagus (the tube that connects the throat and stomach), stomach and duodenum (first segment of the small intestine).


Purpose
The general purpose of an upper gastrointestinal endoscopy is to evaluate the upper gastrointestinal tract. It allows the doctor to obtain specimens of gastrointestinal fluid or biopsies. In some cases, the procedure provides an alternative to traditional X-rays.

Indications
An upper gastrointestinal endoscopy is often used to evaluate or treat swallowing difficulties, persistent abdominal pain, nausea, vomiting, and upper gastrointestinal bleeding or infections. Endoscopy is often more accurate than traditional X-rays in diagnosing inflammation, ulcers or tumors in the gastrointestinal tract. The procedure can also help doctors differentiate benign ulcers in the stomach or esophagus from malignant (cancerous) growths, as well as monitor healing (after surgery or ulcer treatment, for example).
During an endoscopy, the doctor may remove polyps (growths) or tissue samples for a biopsy (further examination) or do a cytology test (collecting cells with a small brush for further examination). Endoscopy may also be used to remove foreign objects that have been swallowed, put feeding tubes in place, and relieve discomfort associated with tumors, other growths or parts of the gastrointestinal tract that have become constricted. Techniques such as laser therapy, thermal coagulation (using high-frequency currents to destroy tissue), injection therapy, heater probes or electrocautery (using electrical currents to destroy tissue) may be used during the endoscopy.


Patient preparation
The doctor will review your medical history, including your current medications and allergies, and do a physical exam. He or she will discuss the risks and benefits of the endoscopy, and you'll be asked to sign an informed consent document.
If you have a history of bleeding disorders, your blood clotting factors will be checked. Avoiding nonsteroidal anti-inflammatory medications, especially aspirin or other medications containing salicylate, is often recommended for several days before a scheduled endoscopy. These medications may increase the risk of bleeding if a biopsy or electrocautery is done during the endoscopy.

If you have a prosthetic heart valve, a history of bacterial endocarditis (inflammation of the membrane lining the heart) or a significant right-to-left shunt (diverted blood flow), you may need preventive antibiotics before an upper gastrointestinal endoscopy. If you have a significant heart or lung disease, increased precautions will be necessary during the procedure.

Because undigested food can cause vomiting and block the view through the endoscope, you'll be asked not to eat or drink six to 10 hours before the procedure (or as directed by your doctor, depending on the circumstances).

Just before or during the procedure, you may be given medication to relieve any anxiety or discomfort, as well as lessen gastrointestinal activity. Medication is often given intravenously. If a smaller endoscope is used, however, you may only need to have your throat sprayed with a topical anesthetic or gargle with a local anesthetic. In most circumstances, unless an infant or young child is the patient, it's not necessary or preferable to use general anesthesia. Of course, the amount of sedation and pain relief needed varies depending on your age, health history, reason for the endoscopy, degree of anxiety and prior medication use.


Procedure
Upper GI endoscopy is usually done on an outpatient basis, but it may be done in an inpatient setting depending on the exact procedure, as well as your medical history and current health status. Often, the procedure is done by a specialist, such as a gastroenterologist.
First, the tip of the endoscope will be placed in the back of your mouth. You'll be asked to swallow while the doctor exerts mild pressure. Then, small amounts of air will be passed through the scope to improve the doctor's view of the lining of your esophagus. Next, the endoscope will be passed into the stomach and the first and second part of the small intestine. For better viewing, gastrointestinal fluid may be removed from hollow organs or more air may be passed through the endoscope. This is the point where any specific procedures or treatments will be done, as described above. Sometimes, ultrasound (using sound waves to create images of internal body parts) is combined with endoscopy by attaching special equipment to the endoscope or passing an ultrasonic probe through the endoscope.

Endoscopy does not make it hard to breathe, and most patients consider it only slightly uncomfortable. Your vital signs and the level of oxygen in your blood will be monitored carefully throughout the procedure, which typically takes about 15 to 30 minutes.


Postprocedure care
Your vital signs will continue to be monitored after the procedure, and you won't be allowed to drink or eat until your gag reflex returns -- typically within an hour or so. You may experience vomiting or throat discomfort. If air was puffed into your stomach during the endoscopy, you may also have a crampy or bloated feeling. These side effects generally disappear within 24 hours, but you may have mild throat discomfort for several days. Try throat lozenges and gargling warm liquids for relief. Avoid any activities requiring alertness, including driving, until the effects of any medication have worn off.
Your doctor may give additional instructions. He or she will also describe any symptoms that should be reported after the procedure, such as difficulty swallowing, abdominal pain, bleeding or persistent vomiting.


Benefits
Upper GI endoscopy has a variety of benefits:
It often eliminates the need for extensive exploratory surgery.
The doctor can often detect small or surface lesions (sores) that may be overlooked on an X-ray.
A biopsy can be done through the endoscope.
Foreign bodies can be removed in a variety of ways through the endoscope.
The procedure can be used for an emergency diagnosis after ingesting certain chemicals.
The upper gastrointestinal tract can be monitored for healing of ulcers or after surgery.
It can be safely substituted for an X-ray during pregnancy when urgent diagnosis is needed for a suspected gastrointestinal condition.

Risks
If a polyp is removed or any tissue samples are taken, there may be some bleeding after the procedure. The bleeding is usually minimal. People who have heart or lung disorders face the greatest risk of complications, making it especially important to closely monitor blood pressure, heart rate and oxygen status during the procedure.
Rarely, gastrointestinal mucosa (a mucus membrane or layer of moist tissue that lines hollow organs and cavities) may be perforated and require surgical repair. Inhaling blood or other substances is also a rare possibility during endoscopy. Other equally rare complications may include sepsis (an infection of the bloodstream), and thrombophlebitis (inflammation of a vein caused by a blood clot in the vein) from intravenous medications.


When endoscopy isn't appropriate
Endoscopy should not be used if:
You're unable to cooperate, even with medication, or refuse to consent to the procedure.
You have an unstable heart, lung or neck condition.
Your intestines or esophagus are perforated.
You have full thickness wall necrosis of the intestinal tract (the death of certain areas of tissue or bone surrounded by healthy tissue or bone).
Of course, the procedure is not appropriate if the risks outweigh the benefits.


Considerations
Endoscopic retrograde cholangiopancreatography (ERCP) is a technique that uses a side-viewing endoscope and the injection of a radiopaque material to help the doctor examine the biliary tract and pancreatic duct. This procedure is used for diagnostic purposes with obstructive jaundice or pancreatic disease. It also has therapeutic uses, such as electrocautery to relieve an obstruction in the duct.
If the procedure is being done because of obstructive biliary tract disease, an endoscopist trained in decompression techniques may be recommended to perform the procedure. This enables the therapeutic procedure to be done at the same time as the diagnostic test. If a therapeutic endoscopist is not available, a referral or surgical consultation is recommended.


Pregnancy-specific information
Again, upper endoscopy may be done during pregnancy when urgent diagnosis is needed for a suspected gastrointestinal condition. ERCP should be avoided during pregnancy, however, due to the radiopaque materials used.

Senior-specific information
Complications from endoscopy are more common in older adults, who tend to have more medical conditions that can lead to complications during the procedure.