Upper gastrointestinal (GI) endoscopy

ALSO KNOWN AS: Esophagogastroduodenoscopy (EGD)

DEFINITION: An upper gastrointestinal (GI) endoscopy is a diagnostic procedure in which a thin tube with a light and camera is inserted into the throat to evaluate the inside of the esophagus, stomach, and first part of the small intestine (duodenum).

Cancers treated:Esophageal cancer, gastric (stomach) cancer, duodenal cancer

Why performed: An upper GI endoscopy helps identify the cause of unexplained abdominal or chest pain, nausea and vomiting, heartburn, bleeding, and swallowing disorders. It can evaluate tumors, ulcers, and areas of inflammation.

Patient preparation: Patients with heart valve disease, rheumatic heart disease, and other cardiovascular conditions may need to take an antibiotic before the procedure to reduce the risk of infection. Patients must not eat solid foods for eight hours before the procedure, but clear liquids may be allowed until a few hours before the procedure, depending on the specific guidelines of the testing center. Before the procedure, the patient’s health history is assessed, and the potential risks of the procedure are discussed.

Steps of the procedure: The patient will change into a hospital gown. An intravenous (IV) line is inserted into a vein in the patient’s arm to deliver medications. A blood-pressure cuff is placed on the patient’s arm to monitor blood pressure. A small clip placed on the patient’s finger is attached to an oximeter monitor to check the patient’s blood oxygen level, and the patient’s pulse is monitored during the procedure.

The patient lies on the left side during the procedure. A sedative is given (conscious or moderate sedation) so the patient is awake but relaxed and able to respond to the physician’s instructions during the procedure. A pain-relieving medication is infused in the IV, and a local anesthetic is applied via a spray at the back of the patient’s throat to numb it and reduce the natural gag reflex. A mouthpiece is placed in the patient’s mouth, through which the endoscope is passed. The physician may ask the patient to swallow several times to help pass the endoscope down the throat to the stomach. An endoscope is a long, thin, lighted, flexible instrument with a camera on the end that transmits images of the esophagus, stomach, and duodenum onto a video monitor to guide the physician during the procedure. The procedure lasts from twenty to thirty minutes.

If an abnormality such as a polyp or lesion is found during the procedure, instruments can be inserted through the endoscope to remove it. Tissue samples can be removed through the endoscope for biopsy. If bleeding is found during the procedure, a sclerosing agent can be injected, or another instrument can be inserted through the endoscope to stop the bleeding. Endoscopic submucosal dissection and endoscopic mucosal resection are techniques that have been developed that allow doctors to easily remove early-stage cancer and large polyps during upper gastrointestinal endoscopy in a non-invasive way. The advent of single use endoscopes has also lessened the risk of complications due to infection.

After the procedure: The patient is observed in a recovery room for one to two hours as they recover from the effects of the sedation. The patient will receive homegoing instructions from the nurse, including diet restrictions and medication and activity guidelines. The patient should not drive or operate machinery for eight hours after the procedure and should avoid vigorous physical activity after the procedure, as directed by the physician. The patient may have temporary throat soreness for a few days after the procedure, which can be relieved with throat lozenges. If a polyp or tissue sample was removed, the patient may need to avoid aspirin and products containing aspirin, ibuprofen, and anticoagulants for one week. The physician will provide specific guidelines. Within seventy-two hours after the procedure, the patient should call the physician if they experience severe abdominal pain, black or bloody stools, a continuous cough, fever, chills, chest pain, nausea, or vomiting.

Advances have been made in upper gastrointestinal endoscopy that have improved the diagnosis of conditions and their treatment. New image-enhanced endoscopy techniques, including narrow-band imaging, blue laser imaging, and linked-color imaging, have made the differences between healthy and non-healthy cells and structures more apparent. High-definition and magnification techniques used in upper gastrointestinal endoscopy have had the same effect. Artificial intelligence has also advanced the ability of imaging techniques to better interpret the results of endoscopy and offer more accurate diagnoses.

Risks: Complications associated with an upper GI endoscopy procedure are rare, but they may include bleeding and puncture of the stomach lining. The risk of complications associated with the sedation given during the procedure is also rare, occurring in less than one in every ten thousand people, according to the American College of Gastroenterology. In general, most patients experience only a mild sore throat after the procedure.

Results: If the test results indicate that prompt treatment is needed, then the physician will discuss the treatment options with the patient and their family and make the necessary arrangements. The abnormal tissue or sample is sent for analysis in the laboratory to determine if there is a malignancy. If bleeding in the stomach lining or duodenum is found, then a peptic or duodenal ulcer may be diagnosed, and a proton pump inhibitor or H2 antagonist medication may be prescribed. Barrett esophagus, a condition that increases the risk of esophageal cancer, is revealed by upper GI endoscopy in about 10 to 15 percent of patients with symptoms of gastroesophageal reflux disease (GERD).

When the laboratory results are available within two to three days, the physician will notify the patient of the results. If another physician referred the patient for the procedure, they would also receive a copy of the results.

Bibliography

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