Upper GI Endoscopy - Procedures, Risks and Benefits

Introduction:

An upper gastrointestinal (GI) endoscopy is a procedure to detect and treat upper gastrointestinal tract problems. The upper gastrointestinal tract includes the esophagus, stomach, and duodenum (beginning of the small intestine). This procedure is also called esophagogastroduodenoscopy. The procedure is done using an endoscope.

Why Is It Done?

• Investigation: An endoscopy is done to determine the causes of gastrointestinal signs and symptoms such as nausea, vomiting, abdominal pain, difficulty swallowing, unexplained weight loss, and gastrointestinal bleeding.

• Diagnosis: The doctor uses endoscopy to collect tissue samples (biopsy) to diagnose conditions such as :

• Gastroesophageal reflux disease.

• Hiatal hernia (part of the stomach pushes into the diaphragm).

• Narrowing or blockages.

• Celiac disease.

• Crohn’s disease.

• Infections of the digestive tract.

• Anemia.

• Bleeding.

• Inflammation.

• Diarrhea.

• Cancers.

• Treatment: The doctor passes some tools through an endoscope and treats bleeding vessels, stretches the esophagus, and removes a foreign object, polyps, or tumors.

How to Prepare Before Upper GI Endoscopy?

• Fasting Before Endoscopy: The patient is advised to stop eating or drinking four to eight hours before the procedure to ensure the stomach is empty. The patient is advised to take an enema or laxative to prepare the bowel.

• Stopping Medications: Inform the doctor about the medications you are taking one week before the procedure, such as for diabetes, heart problems, and high blood pressure. The doctor advises stopping blood thinners such as Aspirin, Warfarin, or Clopidogrel before the procedure. Inform the doctor about your health conditions such as pregnancy and heart problems.

What Happens During the Procedure?

1. During endoscopy, the patient wears a gown, and the patient is asked to lie on a table on the back or side.

2. First, the patient should remove any jewelry or other objects that may interfere with the procedure.

3. Next, a sedative medication is given through a vein to make the patient feel relaxed.

4. Heart rate, respiratory rate, oxygen level, and blood pressure are monitored during the procedure.

5. An anesthetic spray is sprayed into the mouth to numb the throat area for inserting the tube.

6. Next, a plastic mouth guard is placed to keep the mouth open.

7. Then, the saliva will be suctioned using a suction ejector from the mouth.

8. A thin, long flexible tube is inserted into the mouth and the esophagus, stomach, and duodenum.

9. The endoscope contains a tiny camera to view abnormalities of the digestive tract, which is displayed on a monitor.

10. The doctor inflates air into the tube to expand the esophagus. The endoscope does not interfere with breathing.

11. The doctor also sends some tools to take tissue samples or remove polyps through the tube.

12. After the procedure is completed, the endoscope is slowly removed. The procedure usually takes about 15 to 30 minutes.

What Happens After the Procedure?

After the procedure, the patient is asked to wait for one hour to get off the sedation. The patient is not allowed to eat or drink anything until the gag returns to prevent choking. The patient feels mild abdominal cramping, bloating, gas, and a sore throat. The patient may have mild pain when swallowing. This is normal. The doctor discusses the endoscopy results after the procedure, and if a biopsy is taken, the result will take a week.

What Are the Different Tools Used During endoscopy?

Types of tools used during endoscopy include:

• Flexible Forceps: These tong-like tools are used to take a tissue sample.

• Biopsy Forceps: These are used to remove a tissue sample or a suspicious growth.

• Cytology Brushes: These are used to take cell samples.

• Suture Removal Forceps: These are used to remove stitches inside the body.

What Are the Procedures Combined With Upper GI Endoscopy?

Sometimes endoscopy is combined with other procedures such as:

• X-rays: Endoscopic retrograde cholangiopancreatography is a procedure that helps diagnose and treat problems affecting the liver, pancreas, gallbladder, and bile ducts. In this procedure, an endoscope and X-ray are combined.

• Ultrasound: An endoscopy procedure is combined with ultrasound to show images of the digestive tract. Endoscopic ultrasound can also create images of surrounding organs and tissue.

• Chromoendoscopy: It is a newer endoscopy technique that uses a specialized stain or dye on the lining of the intestine. The dye helps the doctor in better visualization of the intestinal lining.

• Endoscopic Mucosal Resection (EMR): It is a technique used to remove cancerous tissue in the digestive tract. In this procedure, a needle is passed through the endoscope, which injects a liquid under the abnormal tissue. This helps to separate the cancerous tissue from the surrounding layers so it can be more easily removed.

• Narrow Band Imaging (NBI): This technique uses a special filter to create more contrast between blood vessels and the lining of the intestine.

• Capsule Endoscopy: Capsule endoscopy is a new technique that has been approved for use in the United States since 2001. Capsule endoscopy has a wireless camera. The camera is small enough and can be fit into a capsule and can, therefore, be swallowed.

As the capsule enters the digestive tract, it takes thousands of pictures of the inside of the stomach, and the images are transmitted to a device. Capsule endoscopy is used to image the small intestine region that is difficult to image using standard endoscopy. The capsule passes through the digestive system within 24 to 48 hours.

What Are the Benefits of Upper GI Endoscopy?

• Upper GI endoscopy is used to diagnose and treat problems in the digestive system.

• It is one of the safest medical procedures that carry a low level of risk.

• It is a quick procedure that can be completed within 30 minutes.

• The procedure is not painful and most people experience only mild discomfort.

What Are the Risks of Upper GI Endoscopy?

An endoscopy is usually a safe procedure. Some rare complications include:

• Bleeding from the biopsy site.

• Infection.

• Tearing of the gastrointestinal tract.

• Allergic reactions to the sedative.

Conclusion:

An endoscopy is a safe and simple procedure to view the upper digestive tract abnormalities. This is a standard procedure and is minimally invasive.