Upper GI endoscopy, sometimes called EGD (esophagogastroduodenoscopy),
is a visual examination of the upper intestinal tract using a lighted,
flexible fiberoptic or video endoscope. The upper gastrointestinal tract
begins with the mouth and continues with the esophagus (food pipe) which
carries food to the stomach. The J-shaped stomach secretes a potent acid
and churns food into small particles. The food then enters the duodenum,
or small bowel, where bile from the liver and digestive juices from the
pancreas mix with it to help the digestive process.
Due to factors
related to diet, environment, heredity and infection the upper GI tract
is the site of numerous disorders. These can develop into a variety of
diseases and/or symptoms. Upper GI endoscopy helps in diagnosing and often
in treating these conditions:
can develop in the esophagus, stomach or duodenum and occasionally can
¨ tumors of the stomach or esophagus
¨ difficulty in swallowing
¨ upper abdominal pain or indigestion
¨ intestinal bleeding—hidden or massive bleeding can occur for
¨ esophagitis (and heartburn)—chronic inflammation of the esophagus
due to a back up of stomach acid and digestive juices
¨ gastritis—inflammation of the lining of the stomach
It is important
not to eat or drink anything for at least eight hours before the exam.
The physician instructs the patient about the use of regular medications,
including blood thinners, before the exam.
endoscopy is usually performed on an outpatient basis. The throat is often
anesthetized by a spray or liquid. Intravenous sedation is usually given
to relax the patient, deaden the gag reflex and even cause short-term
amnesia. For some individuals who can relax on their own and whose gagging
can be controlled, the exam is done without intravenous medications. The
endoscope is then gently inserted into the upper esophagus. The patient
can breath easily throughout the exam. Other instruments can be passed
through the scope to perform additional procedures if necessary. For example,
a biopsy can be done in which a small tissue specimen is obtained for
microscopic analysis. A polyp or tumor can be removed using a thin wire
snare and electrocautery (electrical heat). The exam takes from 15 to
30 minutes, after which the patient is taken to the recovery area. There
is no real pain with the procedure and patients seldom remember much about
exam, the physician will explain the results to the patient and family.
If the effects of the sedatives are prolonged, the physician may suggest
an interview at a later date when the results can be fully understood.
If a biopsy has been performed or a polyp removed, the results are not
available for three to seven days.
GI endoscopy is performed primarily to identify and/or correct a problem
in the upper gastrointestinal tract. This means the test enables a diagnosis
to be made upon which specific treatment can be given.
tests to upper GI endoscopy include a barium X-ray and ultrasound (sonogram)
to study the organs in the upper abdomen. These exams, however, do not
allow for a direct viewing of the esophagus, stomach and duodenum, removing
of polyps or taking of biopsies. In addition, study of the stools, blood
and stomach juice can provide indirect information about a gastrointestinal
mild sore throat sometimes occurs after the exam. Serious risks with upper
GI endoscopy, however, are very uncommon. One such risk is excessive bleeding,
especially with removal of a polyp. In extremely rare instances, a perforation,
or tear, in the esophagus wall can occur. These complications may require
hospitalization and, rarely, surgery. Quite uncommonly, a diagnostic error
or oversight may occur. Due to the mild sedation, the patient should not
drive or operate machinery following the exam. For this reason, a driver
should be available.