Upper Gastro Intestinal Endoscopy
In this article
I do offer high quality objective oriented diagnostic and therapeutic upper GI endoscopy.
What is Upper GI Endoscopy?
Sometimes also called upper endoscopy, EGD/OGD or esophago-gastro-duodenoscopy or oesophago-gastro-duodenoscopy. This is a procedure in which an endoscope - a flexible tube with a camera is inserted through the mouth to see the lining of your upper GI tract. The upper GI tract includes your food pipe (oesophagus), stomach, and the first part of your small intestine (the duodenum).
Why do you need a specialist?
A specialist in gastrointestinal diseases has received special training in endoscopy. They do more UGI endoscopy than any other specialty. Therefore, a specialist will be able to identify subtle changes in the mucosa and properly target biopsies thus accurately diagnose. Also properly trained specialists will know how to avoid dreaded pitfalls and complications hence will be safer for the patient.
Do you have to get admitted?
No. In most cases, you only need to be fasting for 6 hours for solid food and milk. However you can drink water up to 2 hours prior to the procedure. This procedure is well tolerated hence can be done as a day case.
Why do you need UGIE?
In many abdominal problems, this helps to either pinpoint the cause of the symptoms therefore to provide the specific treatment. Sometimes, this can be used to treat the problem itself. In many more instances this procedure will exclude some of the diagnoses in the workup.
Symptoms Warrenting an UGIE:
- Problems of swallowing
- Acid reflux
- Regurgitation
- Persistent heartburn
- Upper abdominal pain
- Nausea and/or vomiting
- Bleeding or vomiting of blackish/bloody content
- Unexplained weight loss
- Anaemia / low haemoglobin
- Barrett’s oesophagus (diagnosis and surveillance)
Diseases Identifiable in UGIE:
- Gastroesophageal reflux disease
- Hiatal hernia
- Gastritis / duodenitis
- Helicobacter Pylori infection
- Gastric and duodenal ulcers
- Larger than normal veins in your oesophagus (oesophageal varices)
- Barrett’s oesophagus
- Pharyngeal, oesophageal, gastric, duodenal, periampulary cancers and tumours
- Celiac disease
- Narrowing of the oesophagus, stomach, duodenum and blockages
- To Check for damage after ingestion of harmful chemicals
What are Biopsies?
During UGIE, biopsies (small pieces of inner lining) taken out to be examined under a microscope and/or for other testing. These biopsies will help to diagnose the following conditions:
- Cancer
- H Pylori infection
- Atypical infections (fungal/parasitic)
- Potentially harmful mucosal changes or narrowings
- Celiac disease
- Gastritis / Duodenitis
Conditions that can be treated using UGIE:
- Bleeding from ulcers and esophageal varices
- Dilate or open up strictures with a small balloon passed through the endoscope
- To remove objects, including food / foreign bodies, that may be stuck in the upper GI tract
- To remove polyps or other growths
- To place feeding tubes or drainage tubes
How is the UGIE done?
This will be done in endoscopy suite of the hospital as an out patient. No need to be admitted unless specified.
The patient is requested to be present in the morning at the given time with 6 hours of fasting for solid foods and milk. The patient may take water up to two hours prior to the procedure. If the patient is taking regular oral medication, they may have to be delayed until the procedure is over.
If the patient is having problems of swallowing or vomitting, a prolonged period of fasting will be recommended.
This procedure can be done without sedation. However, sedation can be given in case of necessity or patient preference. The sedative will be given to you through an intravenous (IV) needle in your arm. If sedatives given, the patient has to be monitored in the hospital for a prolonged period. Also may not be able to drive on the same day afterwards. Arrange for a ride home or come with someone to accompany you home.
Prior to the procedure, you have to declare all your known allergies. You have to remove all your dentures and if there are loose teeth, its pertinent to mention it to the surgeon prior to the procedure (if teeth become dislodged during the procedure, it can have grave complications). You need to disclose all prescribed and over-the-counter medicines, vitamins, and supplements you take, including
- Aspirin or medicines that contain aspirin
- Arthritis medicines
- Blood thinners such as warferrin or clopidogrel
- Blood pressure medicines
- Diabetes medicines including insulin and last dose
- Nonsteroidal anti-inflammatory drugs such as ibuprofen and naproxen
You can take most medicines as usual, but you may need to adjust or stop some medicines for a short time before your upper GI endoscopy especially, warferrin and clopidogrel.
If all is well, a throat spray is given to you to numb your throat and to help prevent you from gagging during the procedure.
The health care staff will monitor your vital signs and keep you as comfortable as possible.
You’ll be asked to lie on your side on an exam table. The surgeon will carefully pass the endoscope down your throat and oesophagus and into your stomach and duodenum. The endoscope does not interfere with your breathing. A camera in the endoscope will send a video to a monitor, allowing close examination of the lining of your upper GI tract. The endoscope pumps air into your stomach and duodenum, making them easier to see but this may cause you some discomfort and urging you to belch out air. Its better if you can resist this urge.
The upper GI endoscopy often takes between 15 and 30 minutes.
What to expect after the UGIE?
After an UGIE, you can expect the following:
- You cannot swallow properly for atleast two hours post procedure due to numbing of your throat
- If you were sedated, to stay at the hospital for 1 to 2 hours after the procedure so the sedative can wear off
- If you were sedated, you are not suitable to drive. You need someone to take you home
- To rest at home for the rest of the day
- You will experience bloating or nausea for a short time after the procedure
- Sometimes there may be a sore throat for 1 to 2 days
- You may go back to your normal diet once your swallowing returns to normal (after about two hours)
Some results from an UGIE including pictures are available right away. The surgeon will share these results with you or, if you choose, with your friend or family member. A pathologist will examine the samples of tissue, cells, or fluid that were taken to help make a diagnosis. Biopsy results take a 10-14 days or longer to come back. The pathologist will send a report to the hospital to recollected by you to discuss with the surgeon.
What are the risks of an UGIE?
Upper GI endoscopy is considered a safe procedure. The risks of complications from an upper GI endoscopy are low, but may include
- Bleeding from the site where the doctor took the tissue samples or removed a polyp
- Perforation in the lining of your upper GI tract
- An abnormal reaction to the sedative, including breathing or heart problems
Bleeding caused by the procedure often is minor and stops without treatment. Serious complications such as perforation are very rare. Your doctor may need to perform surgery to treat some complications. Your doctor can also treat an abnormal reaction to a sedative with medicines or IV fluids during or after the procedure. Studies suggest that a complication may occur less than 1 in 5,000 diagnostic endoscopies performed.
Come back to the hospital if you have:
- Chest pain
- Breathing difficulty
- Difficulty of swallowing or throat pain that gets worse
- Vomiting—particularly if your vomit is bloody or looks like coffee grounds
- Pain in your abdomen that gets worse
- Bloody or black, tar-colored stool
- Fever