An upper endoscopy is a procedure whereby the upper part of the gastrointestinal (GI) system is examined, including the esophagus (swallowing tube), the stomach and the duodenum (the first part of the small intestine).
The endoscopist is trained to observe any abnormalities such as inflammation (redness, irritation), bleeding, ulcers, or tumours. Additionally, certain diagnostic and therapeutic procedures can be performed.
Indications for a gastroscopy include:
- Acute upper gastrointestinal bleeding;
- Persistent nausea and vomiting;
- Upper abdominal pain, heartburn, or acid reflux;
- Iron deficiency anaemia;
- Difficulty swallowing food and/or liquids;
- Findings on a barium meal;
- Removal of a foreign body; or
- To follow-up on previously found polyps (growths), tumours, or ulcers.
The stomach must be empty to avoid complications such as aspiration, and to facilitate inspection of the lining of the upper gastrointestinal tract. Patients are therefore instructed not to eat or drink for at least 6 hours before the procedure.
Patients may be asked to adjust the dose of their medications or to eliminate specific medications, such as aspirin, prior to the examination. Should a sedative be administered to facilitate the procedure, the patient cannot drive after the procedure and must arrange transport.
What to expect
Prior to the endoscopy, informed consent is signed. A local anaesthetic will be sprayed at the back of the throat to numb sensation and prevent vomiting. The procedure can be performed either with the patient fully conscious, or sedated. The sedative used is injected into a vein, is fast acting, and the recovery is within minutes, but still allows enough time for the procedure to be performed. The vital signs (blood pressure, heart rate, and blood oxygen level) will be monitored before, during, and after the examination. To be safe, patients are asked to remove dentures.
The procedure typically lasts between 10 and 20 minutes and is performed with the patient in the left lateral position. A plastic mouth guard is placed between the teeth to prevent damage to the teeth and scope.
The gastroscope is a flexible tube which allows the doctor to look at a magnified image of the upper gastrointestinal tract on a TV monitor. It is possible to see small changes in tissue and to obtain biopsies (small pieces of tissue), remove polyps and introduce or withdraw fluid or air through channels of the instrument. These procedures do not hurt since the lining of the upper gastrointestinal tract does not sense any pain. Air is introduced through the scope so that the scope can be moved forward and to allow the endoscopist to see.
The patient will be asked to swallow the tube; many patients do not remember this after the medications have taken effect. Patients may experience a mild discomfort as air distends the tissue. This is not harmful and belching may relieve the sensation. The endoscope does not interfere with breathing.
After the endoscopy, patients will be observed while the sedative medication wears off. The medicines cause most patients to feel tired or have difficulty concentrating, and patients should not drive or return to work after the procedure.
The most common discomfort after the examination is a feeling of bloating as a result of the air introduced during the examination. This should resolve quickly. Some patients also have a mild sore throat. Most patients are able to eat a few hours after the examination.
Although uncommon, possible complications include:
- Aspiration of food or fluids into the lungs;
- The endoscope can cause a tear or hole in the tissue being examined. This is a serious complication, and occurs only very rarely;
- Bleeding from biopsies or the removal of polyps is usually minimal and easily controlled;
- Reactions to the sedative medications are possible; and
- The medications can also produce irritation in the vein at the site of injection.