Upper endoscopy is a routine, outpatient procedure in which the inside of the upper digestive system is examined. An endoscope as used in the field of gastroenterology (the medical study of the stomach and intestines) is a thin, flexible tube that uses a lens or miniature camera to view various areas of the gastrointestinal tract. When the procedure is limited to the examination of the inside of the gastrointestinal tract's upper portion, it is called upper endoscopy or
esphagogastroduodenoscopy (EGD). With the endoscope, the esophagus (swallowing tube), stomach, and duodenum (first portion of the small intestine) can be easily examined, and abnormalities frequently treated. Patients are usually sedated during the exam.
Upper endoscopy allows a doctor to see inside the esophagus, stomach and top portions of the small intestine. Bronchoscopy examines the large airways inside the lungs (bronchi). Sigmoidoscopy and colonoscopy examine different parts of the lower digestive tract. Each type of endoscopy uses a slightly different endoscope with a different name — an upper endoscope for upper endoscopy, a bronchoscope for bronchoscopy, a sigmoidoscope for sigmoidoscopy and a colonoscope for colonoscopy. Other endoscopes allow doctors to see inside the abdomen and inside joints through small incisions.
The amount of pain or discomfort you feel depends on the area of the body being examined. A sigmoidoscopy (examination of the rectum and lower colon) rarely requires pain medication, while bronchoscopy, colonoscopy and upper endoscopy usually require a sedative. Endoscopy procedures vary in length: 10 to 15 minutes for sigmoidoscopy, 20 to 30 minutes for upper endoscopy, about 30 minutes for bronchoscopy, and 30 to 45 minutes for colonoscopy.
When treating conditions in the upper gastrointestinal tract, small instruments are passed through the endoscope that can stretch narrowed areas (strictures), or remove swallowed objects (such as coins or pins). In addition, bleeding from ulcers or vessels can be treated by a number of endoscopic techniques.
What preparation is required for upper endoscopy?
The upper intestinal tract must be empty for the procedure, so it is necessary not to eat or drink for at least 6-12 hours before the exam. Patients need to inquire about taking their medications before the procedure.
The amount of preparation needed for endoscopy depends on what part of the body is being examined. For an upper endoscopy, you will be instructed not to eat or drink for six to eight hours before the test. For sigmoidoscopy, you will need to do an enema before the test. For a colonoscopy, you will need to clear your bowels completely of stool before the procedure. To do this, you will modify your diet and take laxatives the day before the procedure. In some cases, you may be asked to use an enema the day of the procedure. Before bronchoscopy, you will need to follow restrictions on eating and drinking, and take special precautions regarding your mouth and teeth. Your doctor will give you specific details.
Before any endoscopy, remind your doctor of your medical and surgical history. Tell your doctor if you have any allergies. If you are a woman and there is any chance that you might be pregnant, tell your doctor. You will need a sedative for a bronchoscopy, colonoscopy and upper endoscopy. You will not be allowed to drive after the procedure because the sedative may make you less alert for the few hours immediately after the procedure. Arrange in advance for someone to drive you home.
How is upper endoscopy performed?
During the procedure, a physician uses an endoscope (a long, thin, flexible instrument about 1/2 inch in diameter) to examine the inside of the upper digestive system. A "topical" (local) medication to numb the gag reflex is given either by spray or is gargled. Patients are usually sedated for the procedure (though not always) by injection of medications into a vein. The endoscopist then has the patient swallow the scope, which is passed through the upper gastrointestinal tract. The lens or camera at the end of the instrument allows the endoscopist to examine each portion of the upper gastrointestinal tract; photos can be taken for reference. Air is pumped in through the instrument to allow proper observation. Biopsies and other procedures can be performed without any significant discomfort
What're the risks associated with upper endoscopy?
EGD is safe and well tolerated; however, complications can occur as with any procedure. These are most often due to medications used during the procedure, or are related to endoscopic therapy. The overall complication rate of EGD is less than 2%, and many of these complications are minor (such as inflammation of the vein through which medication is given). However, serious ones can and do occur, and almost half of them are related to the heart or lungs. Bleeding may occur from a biopsy site or where a polyp was removed. Bleeding is usually minimal and rarely requires blood transfusions or surgery. Irritation may occur at the vein where medications were given, sometimes leaving a tender lump lasting several weeks. Applying hot moist towels may help relieve discomfort. Other rare risks include a reaction to the sedatives used, aggravation of heart or lung diseases, or perforation (a tear that might require surgery for repair).