Upper Gastrointestinal Endoscopy
In this test,
a flexible, lighted viewing tube (endoscope) is passed into the
throat and through the esophagus, the stomach, and the uppermost
portion of the small intestine, or duodenum. Fiberoptic cables
permit a physician to visually inspect the lining of these digestive
organs for any signs of disease or abnormality; in some cases,
instruments are passed through the scope to obtain tissue biopsies
for microscopic examination. An endoscopy may also be done therapeutically,
for example, to remove polyps, control bleeding, or remove a
Purpose of the Test
To detect abnormalities
of the esophagus, stomach, and duodenum, particularly in people
with gastrointestinal (GI) symptomssuch as heartburn, difficulty
swallowing, weight loss, abdominal pain, and diarrheathat
have not been explained by contrast x-rays such as a barium swallow
or upper GI series.
a diagnosis of esophageal or stomach cancer or some other abnormality
found on a contrast x-ray.
the stomach or duodenum after surgery.
to remove polyps, widen narrowed passages, stop active bleeding,
or remove obstructions.
Who Performs It
who is trained in endoscopic procedures.
should not be done in people with uncontrolled bleeding in the
GI tract (until they are stable); those with esophageal diverticula
(abnormal outpouchings); if there is a suspected perforation
of the GI tract; or in people who have had recent upper GI surgery.
may not be possible if food or blood is present in the stomach.
You must wait
at least 2 days after having a barium test before undergoing
this procedure; the presence of barium interferes with visual
This test may
provoke some anxiety, but it is not painful. You will not be
able to speak when the scope is in your throat, but your breathing
will not be affected.
In some cases,
an extra long endoscope may be used to visualize or perform biopsies
of the small intestine beyond the duodenum; this procedure is
known as enteroscopy.
Before the Test
You will be
instructed to fast for 6 to 12 hours before the test.
doctor if you regularly take nonsteroidal anti-inflammatory drugs
(such as aspirin, ibuprofen, or naproxen). These medications
must be discontinued for 7 days before the test to reduce the
risk of bleeding.
If you wear
dentures, contacts, or glasses, remove them prior to the test.
medication will likely be administered through an intravenous
(IV) catheter inserted in a vein in your arm. You may drift into
a light sleep during the procedure.
What You Experience
You lie on
your left side on a table.
A local anesthetic
(such as lidocaine) is sprayed into your mouth and throat to
suppress the gag reflex when the scope is inserted. A plastic
mouthpiece may be inserted to hold your mouth open and prevent
you from biting down on the scope.
Next, you will
bend your head forward and open your mouth. The doctor will guide
the scope into your throat with his finger. When the scope reaches
a certain point, the doctor will straighten your head to aid
the advancement of the scope down through your esophagus.
the doctor may instill a small amount of air through the scope
to dilate the esophagus and stomach for better viewing. This
may cause you to belch or pass gas.
carefully inspects the lining of your esophagus, stomach, and
duodenum, looking for any abnormalities.
a biopsy forceps or other instruments may be inserted through
the scope to obtain tissue samples or cells for laboratory analysis.
If necessary, surgical treatments may be performed through the
scope, such as obliteration of polyps with heat.
of the visual inspection, excess air and gastric secretions are
removed through the scope, and the scope is withdrawn.
usually takes from 20 to 30 minutes.
Risks and Complications
include bleeding from a biopsy site; aspiration of stomach contents
into the lungs; low blood pressure or breathing difficulties
due to oversedation; and inadvertent perforation of the esophagus,
stomach, or duodenum.
After the Test
You will rest
in a recovery room until the sedative medication wears off. Your
vital signs will be checked periodically, and you will be observed
for signs of complications. Arrange for someone to drive you
Do not eat
or drink until your gag reflex returns, usually in a few hours.
(Touching the back of the throat with a tongue depressor tests
for this reflex.)
You may experience
belching, flatulence, or gas pains after the procedure.
You may feel
hoarse or have a sore throat for several days. Lozenges or a
warm saline gargle may provide some relief.
If a biopsy
was performed, you may have black, tarry stools due to bleeding
for a short period of time.
doctor immediately if you develop a fever, or if you experience
persistent difficulty swallowing; black, tarry stools; or bloody
will note any abnormalities such as bleeding, inflammation, abnormal
growths, or ulcers that were discovered during the visual inspection.
tests may be necessary to pinpoint a diagnosis. For example,
tissue samples may be cultured to identify the presence of infectious
organisms, such as Helicobacter pylori (a bacterium believed
to be responsible for some stomach ulcers). Biopsied tumors and
excised polyps are examined under a microscope for signs of cancer
or another abnormality.
From The Johns
Hopkins Consumer Guide to Medical Tests. You can order
this book now on our secure server.