Upper endoscopy of the gastrointestinal tract is a painless procedure that evaluates the esophagus, stomach and the first part of the small intestine called the duodenum. Your doctor performs the exam using a long, thin, flexible tube about as big in diameter as your pinky finger. Patients are sedated for comfort just prior to performing the exam.
Do not eat or drink after midnight.
What is an upper GI endoscope?
An upper endoscope is somewhat shorter than a colonoscope, but otherwise similar. This flexible tube has a video camera as well as a bright light so your physician can inspect the inside of your esophagus, stomach and duodenum. The scope also has a channel through which instruments can be placed to take biopsies, remove polyps, or inject medications in special circumstances.
What organs constitute the upper GI tract?
Food passes from your mouth into your esophagus which lies behind your larynx and trachea or your wind pipe. The esophagus passes through your chest to meet the esophagus at the level of your diaphragm, more or less behind the very bottom of your sternum. Food is then churned in the acidic environment of the stomach emptying into the first portion of the duodenum. Here the acidic food bolus is neutralized rapidly by juices from the pancreas and the liver which enter from an opening in the duodenum. When performing the upper endoscopy your physician can see the walls of the duodenum but not the pancreas, liver, or gall bladder. The food bolus then passes through the remainder of the small intestine where digestion and absorption occurs.
What problems can upper GI endoscopy detect?
Upper GI endoscopy can detect:
- Inflammation of the esophagus or esophagitis
- Inflammation of the stomach or gastritis
- Precancerous conditions like Barrett's esophagus
- Hiatal hernia
- H. Pylori Infections
- Celiac Disease
- Allergic Conditions
When is upper GI endoscopy used?
Upper GI endoscopy can be used to determine the cause of:
- Abdominal pain
- Nausea and vomiting
- Swallowing difficulties
- Some atypical chest pain
- Unexplained weight loss
- Bleeding of the upper GI tract
An upper GI endoscopy is used to treat bleeding ulcers or to remove objects that become lodged in the upper GI tract such as meat, coins, or other foreign objects.
How to prepare for the upper GI endoscopy
To allow for the best visualization of the upper GI tract, it must be empty. You can make this possible by not eating or drinking for four to eight hours before the procedure. The patient can't have any solid food for eight hours prior to the procedure and must stop drinking fluids four hours before the scheduled appointment time.
Should you stop any of your medications before upper GI endoscopy?
Patients should tell their doctors about all health conditions they have especially heart and lung problems, diabetes and allergies. Patients should also bring a complete list of all medications they are taking. Your doctor may ask you to temporarily stop taking medications that affect blood clotting.
Medications that may be restricted before and after your upper GI endoscopy include:
- Nonsteroidal anti-inflammatory drugs including aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn) and prescription anti-inflammatories
- Blood thinners
- Diabetes medications
- Some dietary supplements
How is upper GI endoscopy performed?
After checking in at the appropriate time stated on your instructions, you will be asked a series of questions. Afterwards, an intravenous (IV) catheter is placed in a vein in your arm. You will be wheeled on a gurney into the exam room. Once your vital signs have been established, medication will be given to sedate you. Usually you will be given a sedative called midazolam that is in the same class as diazepam. You may also be given a pain medication, either meperidine or Fentanyl. This mixture provides a light sedation, helping you relax and become comfortable.
Once you are very comfortable, the doctor gently inserts the endoscope through the mouth into the esophagus, not entering the wind pipe. You will still be able to breath easily around the endoscope. The physician then passes the scope through the esophagus into the stomach. The scope is then passed through the bottom of the stomach and through the opening called the pylorus into the first part of the small intestine, the duodenum. Air is passed through the endoscope to inflate the esophagus, stomach and duodenum to make it easier to see the lining. Thin tools are then passed through the endoscope allowing the doctor to perform biopsies of the lining of the upper GI tract, to remove growths, or control bleeding. The procedure lasts about 10 minutes.
Recovery from upper GI endoscopy
Once the procedure is completed, patients are moved on the gurney to a recovery room where they will wait about half an hour for the sedative to wear off. Patients often experience bloating or nausea which usually resolves quickly. Some may experience a sore throat that may last a day or two. Upon discharge from the endoscopy lab, patients may feel drowsy or tired and should plan to rest the remainder of the day. Patients may resume their normal diet and medications immediately after leaving the facility unless otherwise directed.
The visual findings of upper endoscopy are available immediately after the procedure. The doctor will often share the results with the patient and any designated family or friends accompanying the patient after the sedative has subsided. Biopsy results are usually available in one week. A letter is then usually sent to the patient regarding those results and when follow up is recommended.
Driving a motor vehicle or operating machinery is not permitted for 12 - 24 hours after an upper GI endoscopy to allow sedatives time to completely wear off. Therefore, patients must arrange for a ride home from the procedure ahead of time.