An upper endoscopy is a procedure that allows a physician to examine the upper part of the gastrointestinal (GI) system, which includes the esophagus (swallowing tube), the stomach, and the duodenum (the first section of the small intestine).
An endoscopist will perform the procedure; this is a doctor who has special training in using an endoscope to examine the upper GI system, looking for inflammation (redness, irritation), bleeding, ulcers or tumours.
Why you need an endoscopy
The most common reasons for upper endoscopy include: Persistent nausea and vomiting;Upper abdominal pain, heartburn, or acid reflux symptoms (an acid or burning sensation in the throat or chest); GI bleeding (vomiting blood or blood found in the stool); difficulty swallowing; food/liquids getting stuck in the esophagus;Abnormal or unclear findings on an upper GI x-ray; Removal of a foreign body and to follow-up on previously found polyps (growths), tumours, or ulcers.
Specific instructions regarding how to prepare for the examination will be given before the procedure, to maximize the patient's safety during and after the examination and to minimize possible complications.
Patients will be asked not to eat or drink anything for six 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 people will be asked to adjust the dose of their medications or to eliminate specific medications prior to the examination. Some medications need to be discontinued for several days. Patients should ask about their specific medications since some medicines are more important than others.
Patients at times will also be instructed to 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 changes in the reflexes and judgment and interfere with the ability to drive or make decisions coherently (similar to the effects of alcohol).
What you can expect
Prior to the endoscopy, the doctor will review the procedure, including possible complications, and will ask patients to sign a consent form.
At times an intravenous line a needle in a vein in the hand or arm) will be inserted to administer medications. The intravenous line insertion feels like a pin prick, similar to having blood drawn.
The vital signs (blood pressure, heart rate, and blood oxygen level) will be monitored before, during, and after the examination. Some patients will be given oxygen during the examination. For safety reasons, dentures should be removed before the procedure.
The procedure typically takes between 5 and 10 minutes. The endoscopy is performed while the person lies on their left side. Some people will be given 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 is a flexible tube with a lens and a light source that allows the endoscopist to either look into the scope or at a TV monitor. If the image is reflected on a TV monitor, it is magnified many times so the endoscopist can see small changes in the tissue. The patient will be asked to swallow the tube; many patients do not remember this after the medications have taken effect. Most people have no difficulty swallowing the tube as a result of the sedating medications. Many people sleep during the test; others are very relaxed and generally not aware of the examination.
The endoscopist may take tissue samples (biopsies) or perform specific treatments (such as dilation, removal of polyps, treatment of bleeding), depending upon the reason for the procedure and what is found during the examination. These treatments are not painful. 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 visualize all of the structures. Patients may experience a mild discomfort as air distends the tissue. 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, if sedative medicines have been used, patients will be observed for about one hour while the medication wears off. The medicines cause most patients to 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 should resolve quickly. Some patients also have a mild sore throat. Most patients are able to eat about 30 - 45 minutes 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 refraining from eating or drinking for several hours 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 very rarely. Bleeding can occur from biopsies or the removal of polyps, but 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 can also produce irritation in the vein at the site of the intravenous line.
The following signs and symptoms should be reported immediately: Severe abdominal pain (more than gas cramps), a firm, distended abdomen, vomiting, temperature greater than 101ºF or 38ºC, difficulty swallowing or severe throat pain, a crunching feeling under the skin.
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.
(The writer is Consultant Physician & Gastroenterologist, Sri Lanka Police Hospital, Colombo)