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What is upper GI endoscopy?
Upper GI endoscopy is a diagnostic procedure that visualises the upper part of the gastrointestinal tract (the oesophagus, the stomach and the duodenum (see illustration). A gastroscope or simply endoscope (since it is the most commonly performed type of endoscopy, the ambiguous term 'endoscopy' refers to UGIE by default) is a narrow, flexible, tube-like telescope that transmitts color pictures from whitin the body to a TV-screen.
UGIE is an investigation which is done often and at most hospitals. Most of these investigations are routinely done as an out-patient or day case. Some specialists even do this examination outside hospitals.
Why submitt to an UGIE?
Symptoms that seem to come from the upper part of your digestive tract, can be vague and difficult to pinpoint. A diagnosis that is based on the medical history alone, is not always enough. UGIE is the preferred investigation to reveal several conditions. The investigation is used to check for certain signs of disease in the intestinal mucosa such as inflammation, ulcers and early signs of cancer. UGIE may also be performed to check that ulcers in the stomach heals normally. Upper gastrointestinal bleeding might call for an UGIE to find the source of the bleeding, which often is a bleeding ulcer in the stomach.
Sometimes the doctor that performs the investigation can't say for certain if the tissue in the GI lining is normal. When that is the case, a biopsy might be nessessary. This is especially important if the doctor suspects a malignant tumor. Small biopsies from the suspected tissue can be made with a pincer (biopsy forceps) which is passed through the scope. A biopsy allows the pathologist to render an opinion on later histologic examination of the biopsy tissue, for instance to confirm malignancies.
It is also possible to perform small therapeutic procedures through the scope. Cutting off small pieces of tissue with a snare device (e.g. polyps, endoscopic mucosal resection) is one example of this. The snare device is placed over the tumor or base of the polyp. Electric current is then released through the snare, and the selected tissue is then removed without much bleeding. The tissue is then brought out and studied closer under a microscope by a pathologist.
About the procedure
The endoscopic procedures can vary somewhat from place to place, but the following is usually true:
- The procedure needs to be done inside an empty stomach. You will be told not to eat for at least 6 hours before the procedure, usually that means that you should not eat, drink or smoke after midnight the day before the examination.
- If you normally take medication such as insulin or blood thinners such as warfarin, you should contact your doctor so that the medication can be adjusted. If you are using warfarin, you might be advised to stop taking the medication for the the last 2-4 days before the procedure. This is to avoid excessive bleeding due to the UGIE.
- If you are using other medicine, like acetylic acid or NSAIDs, you should avoid these the last 5 days before the procedure.
- You may be given a sedative to help ensure that you are relaxed and comfortable during the procedure. If this is the case, you will be adviced not to drive home after the procedure.
- If you have known structural abnormalities in your heart, you might need prophylactic antibiotics to avoid an infection in your heart. Ask your doctor about this if you are in doubt.
How is the procedure performed?
Just before the UGIE your doctor may spray a local anaesthetic into the back of your throat, or give you a lozenge to suck to numb the throat area. This anaestatic will provide an effect that lasts for about 30 minutes. If you are having sedation, a small plastic tube (cannula) will usually be placed in a vein on the back of your hand. The sedative will be injected through the cannula. A mouth-guard is placed between the teeth, partly to protect your teeth, but more importantly to prevent you from biting on the very expensive endoscope. If you have them, you will be asked to take out any removable dentures or dental plates.
The tube/endoscope is thinner than much of the food you swallow, about the diameter of your finger.
The endoscope is then passed over the tongue and into the upper part of the throat (oropharynx). The endoscope is gradually advanced down the esophagus making note of any pathology. The endoscope is quickly passed through the stomach and through the pylorus to examine the first and second parts of the duodenum (see illustration).
Air is then usually pumped through the tube and into the stomach to make it expand, and the stomach lining will be easier to see. When this happens, you may briefly feel a sensation of pressure, fullness or nausea. The prosedure typically lasts for about 10 - 30 minutes.
Complications of UGIE are uncommon, but if removal of tissue such as polyps or biopsies are performed, bleeding can occur. As a precaution to this, all patients who have this examination done to them, must wait for 1-2 hours in the hospital after the procedure is finished. During this period you are not allowed to eat or drink. If larger pieces of tissue has been removed during the procedure, you might have to stay overnight in the hospital to ensure that you are close to help in case of bleeding.
The doctor that performs the UGIE can inform you about the findings of the investigation. Your family physician will receive a report based upon the procedure and histologically findings within 1-4 weeks. If there are findings that require special follow-up (such as the need for surgery), this will be arranged by either your reffering doctor or the doctor that examined you.
If you experience problems like vomiting blood, black and tar-like stools or strong stomach-aches after the examination, you will be able to access the hospital directly for this.
Do you want to know more?
- UGIE - for healthcare workers