| Upper GI Endoscopy
 Upper
GI endoscopy, sometimes called EGD (esophagogastroduodenoscopy), 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 remarkable 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, environment 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
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. The throat is
often anesthetized by a spray or liquid. Intravenous sedation is usually given
to relax the patient, deaden the gag reflex and cause short-term amnesia. For
some individuals who can relax on their own and whose gagging can be controlled,
the exam is done without intravenous medications. The endoscope is then gently
inserted into the upper esophagus. The patient can breath easily throughout the
exam. Other instruments can be passed through the endoscope to perform
additional procedures if necessary. For example, a biopsy can be done in which a
small tissue specimen is obtained for microscopic analysis. A polyp or tumor can
be removed using a thin wire snare and electrocautery (electrical heat). The
exam takes from 15 to 30 minutes, after which the patient is taken to the
recovery area. There is no pain with the procedure and patients seldom remember
much about it.
Results
After the exam, the physician will explain the results to the patient and
family. If the effects of the sedatives are prolonged, the physician may suggest
an interview at a later date when the results can be fully understood. If a
biopsy has been performed or a polyp removed, the results are not available for
three to seven days.
 Benefits
An upper GI endoscopy 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.
Alternative Testing
Alternative tests to upper GI endoscopy include a barium x-ray and ultrasound
(sonogram) to study the organs in the upper abdomen. Study of the stools, blood
and stomach juice can provide indirect information about a gastrointestinal
condition. These exams, however, do not allow for a direct viewing of the
esophagus, stomach and duodenum, removing of polyps or taking of biopsies.
Side Effects and Risks
A temporary, mild throat irritation sometimes occurs after the exam. Serious
risks with upper GI endoscopy, however, are very uncommon. One such 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. Quite
uncommonly, a diagnostic error or oversight may occur. Due to the mild sedation,
the patient should not drive or operate machinery following the exam. For this
reason, someone else should be available to drive the patient home.
Summary
Upper GI endoscopy is a simple outpatient exam that is often performed with the
patient lightly sedated. The procedure provides significant information upon
which specific treatment can be given. In certain cases, therapy can be
administered directly through the endoscope. Serious complications rarely occur
from upper GI endoscopy. The physician can answer any question the patient has.
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