Upper gastrointestinal endoscopy is a procedure that allows the doctor to visually examine the upper portions of the gastrointestinal tract, using a flexible tool called an endoscope. The endoscope has a light source and projects an image on a video screen. An endoscope may also be used to assist with other diagnostic exams and procedures. For instance, an ultrasound probe can be placed on the end of the endoscope to evaluate how deeply a tumor has penetrated the esophagus or wall of the stomach. An endoscope may be used to assist with placement of a permanent feeding tube or to treat a bleeding ulcer.
Purpose
An upper gastrointestinal endoscopy aids in the investigation of the source of pain, difficulty swallowing, bleeding or other symptoms of an upper abdominal problem. During an endoscopy the doctor can obtain samples of tissue for biopsy, to check for the presence of cancer cells or the bacteria responsible for most stomach ulcers. Various instruments can be passed through the endo-scope to treat problems, such as controlling bleeding due to an ulcer. The procedure may be performed on patients who have had stomach surgery to assess for cancer or the return of an ulcer. It may also be used to monitor patients at high risk for upper gastrointestinal cancers.
Precautions
Patients with a history of heart and lung disease and those with blood-clotting problems require special precautions. For instance, a patient with artificial heart valves or a history of infection of the lining of the heart will need antibiotics to prevent infection. Patients with
an intestinal perforation, or puncture in the gastrointestinal tract, should not have an upper gastrointestinal endoscopy. Patients must be able to cooperate during the procedure. Those who are not able to cooperate are not good candidates for an endoscopy.
Description
An endoscopy may take place in the physician's office or in a hospital. An intravenous (IV) line will be started in a vein in the arm. Through the IV line, the patient generally receives a sedative and a pain-killer if needed. The medication will help the patient feel relaxed and drowsy. A local anesthetic is usually sprayed into the throat to prevent a gag reflex. Dentures are removed. A mouthpiece will help to keep the mouth open. Patients are positioned onto their sides. The doctor slowly advances the lubricated endoscope down the throat, into the stomach. Air will be passed through the endoscope to make it easier for the doctor to see the lining of the gastrointestinal tract. The endoscope will be repositioned to see different parts of the stomach and the small intestine. The exam usually takes less than an hour. The patient is able to breathe independently during the exam. In some cases a biopsy may be taken. Biopsy forceps or a brush used to secure cells are passed through the endoscope. The tissue sample is taken and then removed through the endoscope.
Preparation
The doctor should be informed of any allergies as well as all the medications that the patient is currently taking. The doctor may instruct the patient not to take certain medications, like aspirin and anti-inflammatory drugs that interfere with clotting, for a period of time prior to the procedure. The patient should not eat or drink anything for at least eight hours prior to the endoscopy. The doctor should be informed if the patient has had heart valves replaced or a history of an inflammation of the inside lining of the heart, so that appropriate antibiotics can be administered to prevent any chance of infection. Risks and benefits of the procedure will be explained to the patient. The patient will be asked to sign a consent form.
Aftercare
The patient will be monitored for an hour or two after the procedure, while the effects of the medication wear off. Due to the sedative, the patients will need to arrange for someone to drive them home after the procedure.
Patients may feel bloated due to the air that is introduced into the stomach during the procedure, and may have a sore throat for a couple of days. Patient should contact the doctor if they develop difficulty swallowing, chest pain, severe abdominal pain, throat soreness that becomes more severe or rectal bleeding.
Risks
Endoscopy is usually considered safe when performed by a specially trained physician. As with any invasive procedure it is not risk-free. Complications
include bleeding and perforation (puncturing a hole in the lining of the gastrointestinal tract). Scopes are cleaned and disinfected between patients so any risk of transmitting infectious disease from one patient to another by the endoscope would be negligible.
Normal results
A pale reddish pink lining with no abnormal-looking masses or ulcerations is considered a normal result.
Abnormal results
Evidence of an ulcer or other lesion would be considered an abnormal result. If the biopsy determines the presence of cancer cells, a diagnosis of cancer is made. The appearance of the lesion, including its size or if there are multiple lesions, often helps with staging and treatment plans. An ultrasound probe attached to the endo-scope also may help with staging.
Resources
BOOKS
Fauci, Anthony S. Harrison's Principles of Internal Medicine, 14th edition. New York, NY: The McGraw-Hill Companies, 2000.
Pfenninger, John L. Procedures for Primary Care Physicians, 2nd edition. St. Louis, MO: Mosby-Year Book, Inc, 2000.
Society of American Gastrointestinal Endoscopic Surgeons (SAGES). 2716 Ocean Park Boulevard, Suite 3000, Santa Monica, CA 90405. (310) 314-2404. <http://www.sages.org> 28 June 2001.
American Gastroenterological Association. 7910 Woodmont Ave., Seventh Floor, Bethesda, MD 20814. (301) 654-2055. <http://www.gastro> 28 June 2001.
Debra Wood, R.N.
Biopsy
—Removal of a tissue sample for examination under a microscope to check for cancer cells.
Duodenum
—The first portion of the small intestine.
Endoscope
—A thin, flexible, lighted tube that is passed down the throat and enables the doctor to view the esophagus, stomach lining and duodenum.
Perforation
—Puncture or tear.
Staging
—Determination of how advanced the cancer is.
Ultrasound
—The study of internal organs using high-frequency sound waves.
QUESTIONS TO ASK THE DOCTOR
Did you see any abnormalities?
How soon will you know the results of the biopsy (if one was done)?
When can I resume any medications that were stopped?
