An upper endoscopy, often referred to as endoscopy, EGD, or esophago-gastro- duodenoscopy, is a procedure that allows a physician to directly examine the upper part of the gastrointestinal (GI) tract, which includes the esophagus (swallowing tube), the stomach, and the duodenum (the first section of the small intestine) .
The physician who performs the procedures, known as an endoscopist, has special training in using an endoscope to examine the upper GI system, looking for inflammation (redness, irritation), bleeding, ulcers, or tumors.
REASONS FOR UPPER ENDOSCOPY
- Unexplained discomfort in the upper abdomen
- GERD or gastroesophageal reflux disease, (often called heartburn) (See “Patient information: Gastroesophageal reflux disease in adults”)
- Persistent nausea and vomiting
- Upper GI bleeding (vomiting blood or blood found in the stool that originated from the upper part of the gastrointestinal tract). Bleeding can be treated during the endoscopy.
- Difficulty swallowing; food/liquids getting stuck in the esophagus during swallowing. This may be caused by a narrowing (stricture) or tumor. The stricture may be dilated with special balloons or dilation tubes during the endoscopy.
- Abnormal or unclear findings on an upper GI x-ray, CT scan or MRI.
- Removal of a foreign body (a swallowed object).
- To check healing or progress on previously found polyps (growths), tumors, or ulcers.
Specific instructions regarding how to prepare for the examination will be given before the procedure. These instructions are designed to maximize the patient’s safety during and after the examination and to minimize possible complications.It is important to read the instructions ahead of time and follow them carefully. Do not hesitate to call the physician’s office or the endoscopy unit if there are questions.Patients may be asked not to eat or drink anything for up to eight hours before the test. It is important for the stomach to be empty to allow the endoscopist to visualize the entire area and to decrease the possibility of food or fluid being vomited into the lungs while under sedation (called aspiration).Some patients will be asked to adjust the dose of their medications or to eliminate specific medications (such as aspirin-like drugs) for a period of time before the examination. Patients should discuss their medications with their physician in advance of their appointment for the endoscopy.Patients should arrange for a friend or family member to escort them home after the examination. Although the patient will be awake by the time they are discharged, the medications used for sedation cause temporary changes in the reflexes and judgment and interfere with the ability to drive or make decisions (similar to the effects of alcohol).
WHAT TO EXPECT
Prior to the endoscopy, the staff will review the patient’s medical and surgical history, including current medications. A physician will explain the procedure and ask the patient to sign consent. Before signing the consent, the patient should understand all the benefits and risks of the procedure, and should have all of their questions answered.An intravenous line (a needle inserted into a vein in the hand or arm) will be started to administer medications. The intravenous line insertion feels like a pin prick, similar to having blood drawn. Most of the time, patients are given a combination of a sedative (to help the person relax), and a narcotic (to prevent discomfort). An anesthesiologist (a physician specially trained in administering deep sedation) or a CRNA (Certified Registered Nurse Anesthetist) may also participate in the procedure.Although most patients are sedated for the examination, many tolerate the procedure well without any medication.
Vital signs (blood pressure, heart rate, and blood oxygen level) will be monitored before, during, and after the examination. The monitoring is not painful. Oxygen is often administrated during the procedure through a nasal cannula (a small tube that sits under the nose and is fitted around the ears). For safety reasons, dentures should be removed before the procedure.
The procedure typically takes between 10 and 20 minutes to complete. The endoscopy is performed while the person lies on their left side. Sometimes the physician will give a medication to numb the throat (either a gargle or a spray). A plastic mouth guard is placed between the teeth to prevent damage to the teeth and scope.
The endoscope (also called a gastroscope) is a flexible tube that is about the size of a finger. The scope has a lens and a light source that allows the endoscopist to look into the scope to see the inner lining of the upper gastrointestinal tract, or to view it on a TV monitor. Most people have no difficulty swallowing the flexible gastroscope as a result of the sedating medications. Many people sleep during the test; others are very relaxed and generally not aware of the examination.
An alternative procedure called transnasal endoscopy may be available in some facilities. This involves passing a very thin scope (about the size of a drinking straw) through the nose. The person is not sedated but a medication is applied to the nose to prevent discomfort. A full examination can be performed with this instrument.
The endoscopist may take tissue samples called biopsies (not painful), or perform specific treatments (such as dilation, removal of polyps, treatment of bleeding), depending upon what is found during the examination. Air is introduced through the scope to open the esophagus, stomach, and intestine, allowing the scope to be passed through these structures and improving the endoscopist’s ability to see all of the structures. Patients may experience a mild discomfort as air distends the intestinal tract. This is not harmful and belching may relieve the sensation. The endoscope does not interfere with breathing. Taking slow, deep breaths during the procedure may help the person to relax.
After the endoscopy, patients will be observed for one to two hours while the sedative medication wears off. The medicines cause most patients to temporarily feel tired or have difficulty concentrating and patients should not drive or return to work after the procedure.The most common discomfort after the examination is a feeling of bloating as a result of the air introduced during the examination. This usually resolves quickly. Some patients also have a mild sore throat. Most patients are able to eat shortly after the examination.
- Upper endoscopy is a safe procedure and complications are uncommon. The following is a list of possible complications:
- Aspiration of food or fluids into the lungs, the risk of which can be minimized by not eating or drinking for the recommended period of time before the examination.
- The endoscope can cause a tear or hole in the tissue being examined. This is a serious complication but fortunately occurs only rarely.
- Bleeding can occur from biopsies or the removal of polyps, although it is usually minimal and stops quickly on its own or can be easily controlled.
- Reactions to the sedative medications are possible; the endoscopy team (doctors and nurses) will ask about previous medication allergies or reactions and about health problems such as heart, lung, kidney, or liver disease. Providing this information to the team ensures a safer examination.
- The medications may produce irritation in the vein at the site of the intravenous line. If redness, swelling, or discomfort occurs, a patient should call their endoscopist or their primary care provider, or the number given to them by the nurse upon discharge.
The following signs and symptoms should be reported immediately:
- Severe abdominal pain (more than gas cramps)
- A firm, distended abdomen
- Any temperature elevation
- Difficulty swallowing or severe throat pain
- A crunching feeling under the skin of the neck
Most patients tolerate endoscopy very well and feel fine afterwards. Some fatigue is common after the examination, and patients should plan to take it easy and relax the rest of the day.The endoscopist can describe the result of their examination before the patient leaves the endoscopy unit. If biopsies have been taken or polyps removed, the patient should call for results within one to two weeks