Upper GI endoscopy, sometimes called EGD, is a visual examination of the upper intestinal tract using a lighted, flexible fiberoptic or video endoscope. The upper gastrointestinal tract begins with the mouth and continues with the esophagus (food tube) which carries food to the stomach. The J-shaped stomach secretes a potent acid and churns food into small particles. The food then enters the duodenum, or small bowel, where bile from the liver and digestive juices from the pancreas mix with it to help the digestive process.

EQUIPMENT

The flexible endoscope is a piece of equipment that can be directed and moved around the many bends in the gastrointestinal tract. Endoscopes now come in two types. The original pure fiberoptic instrument has a flexible bundle of glass fibers that collect the lighted image at one end and transfer the image to the eye piece. The newer video endoscopes have a tiny, optically sensitive computer chip at the end. Electronic signals are then transmitted up the scope to the computer which then displays the image on a large video screen. An open channel in these scopes allows other instruments to be passed through in order to take tissue samples, remove polyps and perform other exams.

REASONS FOR THE EXAM

Due to factors related to diet, enviroinment and heredity, the upper GI tract is the site of numerous disorders. These can develop into a variety of diseases and/or symptoms. Upper GI endoscopy helps in diagnosing and often in treating these conditions:

  • Ulcers – which can develop in the esophagus, stomach, or duodenum; occasionally ulcers can be malignant
  • Tumors of the stomach or esophagus
  • Difficulty in swallowing
  • Upper abdominal pain or indigestion
  • Intestinal bleeding – hidden or massive bleeding can occur for various reasons
  • Esophagitis and heartburn – chronic inflammation of the esophagus due to reflux of stomach acid and digestive juices
  • Gastritis – inflammation of the lining of the stomach

PREPARATION

The examination requires that you have an empty stomach. It is important not to eat or drink anything for at least eight hours before the exam. The physician instructs the patient about the use of regular medications, including blood thinners, before the exam.

THE PROCEDURE

Upper GI endoscopy is usually performed on an outpatient basis. A local anesthetic, Xylocaine, will be sprayed into the back of your mouth in order to numb your throat and reduce gagging when the instrument is passed. Intravenous sedation is usually given to relax the patient. If you have a history of allergic reaction to any of these medicines, please inform the examining physician before the medication is given. Due to the mild sedation, the patient should not drive or operate machinery following the exam. For this reason, someone else needs to be available to drive the patient home.

The examination is performed with the patient lying on the left side. A flexible tube will be passed into your mouth and when you swallow, will pass into your esophagus. The physician will then examine your esophagus, stomach, and small intestine before removing the instrument. If any abnormalities are seen, a small piece of tissue can be removed for examination under the microscope using biopsy forceps. You will not feel this sampling process. Also, if a narrowing is seen in the esophagus, the opening can be progressively widened using a series of rubber dilators. The examination takes five to fifteen minutes to perform depending on the findings and the potential need for a biopsy.

RISKS

A temporary, mild throat irritation sometimes occurs after the exam. Serious risks with upper GI endoscopy, however, are very uncommon. One risk is excessive bleeding, especially with removal of a large polyp. In extremely rare instances, a perforation, or tear, in the esophagus or stomach wall can occur. These complications may require hospitalization, and rarely, surgery.

RESULTS

After the exam, the physician will explain the results to the patient and family. If a biopsy has been performed or a polyp removed, the results are not available for three to seven days.

An EGD is performed primarily to identify and/or correct a problem in the upper gastrointestinal tract. This means the test enables a diagnosis to be made upon which specific treatment can be given. If a bleeding site is identified, treatment can stop the bleeding, or if a polyp is found, it can be removed without a major operation. Other treatments can be given through the endoscope when necessary.