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Upper GI endoscopy, sometimes called EGD*, is a visual examination of the
upper intestinal tract using a lighted, flexible fiberoptic or
video endoscope.
*esophagogastroduodenoscopy
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.
Equipment
The flexible endoscope is a remarkable piece of equipment that
can be directed and moved around the many bends in the
gastrointestinal tract. Endoscopes now come in two types. The
original pure fiberoptic instrument has a flexible bundle of
glass fibers that collect the lighted image at one end and
transfer the image to the eye piece. The newer video endoscopes
have a tiny, optically sensitive computer chip at the end.
Electronic signals are then transmitted up the scope to the
computer which then displays the image on a large video screen.
An open channel in the scope allows other instruments to be
passed through it in order to take tissue samples, remove polyps
and perform other exams.
Reasons for the Exam
Due to factors related to diet, environment and heredity, the
upper (31 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.
- ulcers which can develop in the esophagus, stomach or
duodenum and occasionally can be malignant
- tumors of the stomach or esophagus
- difficulty in swallowing
- upper abdominal pain or indigestion
- intestinal bleeding-hidden or massive bleeding can occur for
various reasons
- esophagitis (and heartburn)--chronic inflammation of the
esophagus due to a back up of stomach acid and dige
- gastritis--inflammation of the lining of the stomach
Preparation
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.
The Procedure
Upper GI 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
it.
Results
After the 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.
Benefits
An upper 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. If a bleeding site is
identified, treatment can stop-the bleeding, or if a polyp is
found, it can be removed without a major operation. Other
treatments can be given through the endoscope when necessary.
Alternative Testing
Alternative 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 condition.
Side Effects and Risks
A temporary, 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.
Summary
Upper GI endoscopy is a simple out patient exam that is often
performed with the patient lightly sedated. The procedure
provides significant information upon which specific treatment
can be given. In certain cases, therapy can be administered
directly through the endoscope. Serious complications rarely
occur from upper GI endoscopy. The physician can answer any
question the patient has.
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