Upper Endoscopy

Indication

Upper endoscopy is performed to evaluate problems related to the upper digestive tract, including the esophagus, stomach, and small intestine. Upper endoscopy (EGD) can provide valuable diagnostic information on the following disorders including upper abdominal distress, especially that persisting after an appropriate trial of therapy, persistent esophageal reflux symptoms despite appropriate therapy, swallowing difficulties, persistent vomiting or nausea of unknown cause, X-ray findings of a tumor in the esophagus, stomach, or small intestine, X-ray findings of gastric or esophageal ulcer, evidence of a narrowing of the esophagus, to assess for malignancy, gastrointestinal bleeding, and to determine the presence of esophageal varicies in patients with cirrhosis and portal hypertension.

EGD is also used for periodic surveillance in patients with Barrett's esophagus, in which the abnormal esophageal surface lining carries an increased risk of malignancy. This condition usually developed in individuals with longstanding reflux. Similarly, patients with adenomatous gastric polyps are at increased risk for cancer, and periodic endoscopy is warranted. Follow up EGD is also indicated in selected patients with large esophageal, gastric or stomach ulcers to demonstrate healing.

Preparation

Prior to the procedure, you will need to be on an empty stomach. This allows for the best and safest examination. Typically, you’ll be asked not to take any food or liquids after midnight. In most cases, you will be instructed not take your morning medications. Diabetic patients will need to receive special instructions on their insulin dosing prior to the procedure. Your usual morning medications can be taken soon after the procedure is completed. Also, alert your doctor if you require antibiotics prior to undergoing dental procedures, because you might need antibiotics prior to upper endoscopy as well.

Upon arrival to the outpatient and patient registration areas, you will be taken to the “pre-op” area, where you’ll be greeted by a nurse, who will review your medical history, medications, and questions you may have prior the procedure. The nurse will also review the informed consent for the procedure you will need to sign. Because anesthesia will be used, a small intravenous catheter will be placed.

You will be moved on stretcher to the procedure room, where you will continue to be monitored. Your blood pressure, heart rate, oxygen saturation, and respiratory status will be monitored continuously. Dr. Galati will administer anesthesia, consisting of Demerol and Versed. This type of anesthesia is called “conscious sedation”. If you have a prior allergy to these medications, other similar medications will be substituted.

Procedure

Prior to the procedure, premedication to minimize gagging and enhance patient comfort is used for most examinations. This typically consists of topical pharyngeal anesthesia by spray or gargle and intravenous sedation as noted above. The latter is given slowly and titrated according to the response of the patient.

During the procedure a gastrointestinal assistant and nurse monitors your overall clinical status and comfort level and provides technical assistance to Dr. Galati. You will be positioned on your left side on the examining table. A small plastic bite block will be placed in your mouth to prevent and damage to the instrument or your teeth. The flexible endoscope is guided carefully through the mouth and the patient is instructed to swallow while gentle pressure is applied. The instrument is then passed under direct vision through the esophagus and stomach and generally into the small intestine. Careful inspection of the mucosal surface of the gut is performed, both during scope insertion and during its slow withdrawal. Documentation of findings may be recorded with photographic or video techniques. Channels running through the scope will enable Dr. Galati to obtain biopsy of abnormal areas of interest, or other specimens, or to perform therapeutic procedures such as electrocoagulation, injection sclerotherapy, tumor ablation, foreign body removal, or banding of esophageal varicies.

The procedure usually requires 20 to 30 minutes. At its conclusion the patient is observed during an additional 30 to 60 minute recovery period. When fully awake, the patient is discharged with instructions for follow-up.

Complications

Upper endoscopic procedures (EGD) are relatively safe procedures. Major complications may include bleeding, perforation, aspiration pneumonia, or cardiac events. Large surveys indicate a risk of serious complications during diagnostic EGD of approximately 1 in 800 and a risk of death of approximately 1 in 5,000. In more seriously ill patients, such as those for whom EGD is performed to evaluate active bleeding at the time of the procedure, the risks are higher. In one such series, 1 in 200 patients had major complications of the procedure and the risk of death was 1 in 700. Because of its relative safety, EGD is usually substituted for X-ray in the evaluation of gastrointestinal symptoms in women who may be pregnant.