Upper Gastrointestinal Endoscopy - What Is It and How Is It Done

Upper gastrointestinal endoscopy, often called an endoscopy, is a test to visualize the upper part of the gastrointestinal tract, composed of the esophagus, stomach, and duodenum (the first portion of the small intestine).

Gastrointestinal endoscopy is a procedure usually done by the gastroenterologist and can be used both as a diagnostic medium and for treatment of various problems of the upper gastrointestinal system.

Procedure of upper gastrointestinal endoscopy
Procedure of upper gastrointestinal endoscopy
 


What is upper endoscopy?

Upper gastrointestinal endoscopy is an exam that aims to diagnose and treat some of the most common diseases of the upper gastrointestinal system. Endoscopy can also be called esophagogastroduodenoscopy, because it is an endoscopic examination that allows direct visualization of the interior of the esophagus, stomach and duodenum.

Gastrointestinal endoscopy is done with a device called an endoscope, a long, thin flexible tube that has a camera at its end, allowing the inside of the digestive organs to be filmed. Current endoscopes have high definition imaging and can shoot on HDTV.

The current endoscopes are about 1 meter in length and 8 to 11 millimeters (0.8 to 1.1 cm) in diameter. There are already ultrathin endoscopes that are only 0.5 cm in diameter, but they are not yet so widespread.

The endoscope has a high resolution camera and its own light source, which serves to illuminate the inside of the organs. The device is also capable of aspirating and injecting water to clean secretions that may be hindering the direct visualization of the mucosa of the esophagus, stomach or duodenum.

Gastrointestinal endoscopy is not only used to see and film the inside of the esophagus, stomach and duodenum, it can also be used to perform biopsies and treat some problems, such as bleeding ulcers or varicose veins. Through the endoscope it is possible to introduce a series of tools, such as biopsy forceps, loops, needles, probes for sclerotherapy or electrocautery, balloon for dilatation, nets and baskets. Thus, a variety of procedures can be performed during a upper gastrointestinal endoscopy.

Indications

Upper gastrointestinal endoscopy is a procedure usually indicated in the following situations:
  • Investigation of pain or unexplained discomfort in the upper abdomen.
  • Assessment of the severity of gastroesophageal reflux disease, which does not respond to initial clinical treatment.
  • Cancer screening test in patients with previous diagnosis of Barrett's esophagus.
  • Investigation of persistent nausea and vomiting.
  • Assessment and possible treatment for upper gastrointestinal tract bleeding (such as vomiting with blood or signs of blood being digested in the stool, suggesting the stomach as the cause).
  • Investigation of esophageal varices in patients with cirrhosis and/or portal hypertension.
  • Investigation of anemia due to iron deficiency without definite cause.
  • Investigate pictures of difficulty swallowing food or feeling of food stuck in the esophagus.
  • Removal of foreign body accidentally swallowed.
  • Assess the severity of esophageal damage in patients who ingested caustic soda, bleach (bleach) or any other corrosive substance.
  • To evaluate cure or evolution of polyps, tumors or ulcers found in previous endoscopies.

Upper gastrointestinal endoscopy can also be used to diagnose H.pylori bacterial infections. However, there are other less invasive diagnostic methods that can be used instead of endoscopy. Similarly, after treatment with antibiotics, unless the patient has a gastric or duodenal ulcer, the endoscopy does not need to be repeated to confirm the cure.

Preparation

To maximize results and reduce the risks of complications, every patient who will undergo a gastrointestinal endoscopy should prepare for the exam.

Patients who have a scheduled upper endoscopy should not feed within 4 to 8 hours prior to the test. The right time will be decided by the gastroenterologist, according to the patient's clinical situation. Water can be ingested up to 2 hours before the procedure. It is important that the stomach is empty so that there is no risk of the patient vomiting during the examination and so the doctor can visualize everything inside without being disturbed by food remains.

Most medications can be maintained until the time of endoscopy, so be careful to take them with small sips of water to avoid arriving at the time of the examination with a full stomach. Some medications may need dose adjustments, such as diabetes medications, because of the fasting that should be done for up to 8 hours before endoscopy.

The decision to discontinue antiplatelet medicinal products (eg clopidogrel or ticlopidine) or anticoagulants (eg heparin or warfarin) should be individualized, taking into account the risk of bleeding during endoscopy. Patients who use low-dose aspirin usually do not need to stop it before the procedure.

It is not necessary to take antibiotics before performing a gastrointestinal endoscopy, even in patients at risk of infective endocarditis.

Obviously, if endoscopy is indicated as an emergency, as in patients with active gastrointestinal bleeding, the examination is performed without any preparation.

Sedation and anesthesia for endoscopy

Upper gastrointestinal endoscopy can be done with or without sedation. In most cases the examination is done with the patient awake, with only mild sedation and an opioid analgesic (from the morphine family). An anesthetic spray is also usually used in the throat for the patient to better tolerate the passage of the endoscope. Many patients fall asleep during the examination and others find themselves so relaxed that they hardly bother with the procedure.

Ultra-thin endoscopes can be inserted through the nose and do not require sedation because they cause minimal discomfort. However, as has been said, they are still not used in all cases.

At the end of endoscopy, the patient remains observed for a short time, usually less than one hour, while the effect of the sedative medication disappears. Some of the medications used may cause some temporary feeling of tiredness or difficulty concentrating. The patient is usually instructed not to drive and not return to work until the next day.

The most common discomfort after the examination is a sensation of abdominal distension, which occurs as a result of the air introduced during the examination. This discomfort usually resolves quickly. Some people may complain of a mild sore throat after the test. Most patients are able to eat right after they get home.

How is endoscopy done?

Endoscopy is relatively rapid, with a total duration of 10 to 20 minutes. You do not need to be hospitalized and the patient can return home soon after the end of the exam.

To perform gastrointestinal endoscopy, the patient is placed on the side and an arm vein is punctured for administration of sedative and analgesic drugs. A plastic mouth guard is usually placed between the mouth and the endoscope to prevent the patient from biting it.

The examination begins with the introduction of the endoscope through the mouth, being pushed slowly through the oropharynx, esophagus, stomach and duodenum. As it progresses along the gastrointestinal system, the gastroenterologist will assess the condition of the mucosa and look for lesions. The endoscope is introduced only into the gastrointestinal tract, with no interference in the respiratory tract; the patient does not feel any difficulty in breathing.

If you find suspicious lesions, the doctor can perform biopsies, removing small pieces of the mucosa for later evaluation by a pathologist. A biopsy is a painless procedure. If the doctor finds polyps, they can be removed. In the case of bleeding lesions, the gastroenterologist can cauterize the lesion, stopping the loss of blood. The endoscope also serves to dilate constrictions of the esophagus or to remove foreign objects that have been swallowed.

Complications

Gastrointestinal endoscopy is a very safe procedure, with a low risk of complications in most patients. The current rate of complications of 0.0002% in endoscopies only diagnostic and 0.15% in endoscopies in which an intervention is performed. The risk of perforation of the esophagus or stomach is less than 0.03%.

If the devices are properly sterilized, following international protocols, there is no risk of contracting infections, such as hepatitis or HIV after gastrointestinal endoscopy.
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