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Patient information: Upper endoscopy

AuthorJerome D Waye, Section EditorMark Feldman, MD, MACP, MD AGAF, FACG Deputy EditorAnne C Travis, MD, MSc, FACG
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Contents of this article ENDOSCOPY OVERVIEW REASONS FOR UPPER ENDOSCOPY ENDOSCOPY PREPARATION WHAT TO EXPECT DURING ENDOSCOPY THE ENDOSCOPY PROCEDURE ENDOSCOPY RECOVERY ENDOSCOPY COMPLICATIONS AFTER UPPER ENDOSCOPY WHERE TO GET MORE INFORMATION REFERENCES
GRAPHICS

FIGURES

Upper GI anatomy PI

ENDOSCOPY OVERVIEW An upper endoscopy, often referred to as endoscopy, EGD, or esophago-gastroduodenoscopy, is a procedure that allows a physician to directly examine the upper part of the gastrointestinal (GI) tract, which includes the esophagus (swallowing tube), the stomach, and the duodenum (the first section of the small intestine) ( figure 1). The physician who performs the procedures, known as an endoscopist, has special training in using an endoscope to examine the upper GI system, looking for inflammation (redness, irritation), bleeding, ulcers, or tumors. REASONS FOR UPPER ENDOSCOPY The most common reasons for upper endoscopy include: Unexplained discomfort in the upper abdomen GERD or gastroesophageal reflux disease, (often called heartburn) (see "Patient information: Acid reflux (gastroesophageal reflux disease) in adults") Persistent nausea and vomiting Upper GI bleeding (vomiting blood or blood found in the stool that originated from the upper part of the gastrointestinal tract). Bleeding can be treated during the endoscopy. Difficulty swallowing; food/liquids getting stuck in the esophagus during swallowing. This may be caused by a narrowing (stricture) or tumor. The stricture may be dilated with special balloons or dilation tubes during the endoscopy. Abnormal or unclear findings on an upper GI xray, CT scan or MRI. Removal of a foreign body (a swallowed object). To check healing or progress on previously found polyps (growths), tumors, or ulcers. ENDOSCOPY PREPARATION You will be given specific instructions regarding how to prepare for the examination before the procedure. These instructions are designed to maximize your safety during and after the examination and to minimize possible complications. It is important to read the instructions

ahead of time and follow them carefully. Do not hesitate to call the physician's office or the endoscopy unit if there are questions. You may be asked not to eat or drink anything for up to eight hours before the test. It is important for your stomach to be empty to allow the endoscopist to visualize the entire area and to decrease the possibility of food or fluid being vomited into the lungs while under sedation (called aspiration). You may be asked to adjust the dose of your medications or to stop specific medications (such as aspirin-like drugs) temporarily before the examination. You should discuss your medications with your physician before your appointment for the endoscopy. You should arrange for a friend or family member to escort you home after the examination. Although you will be awake by the time you are discharged, the medications used for sedation cause temporary changes in the reflexes and judgment and interfere with your ability to drive or make decisions (similar to the effects of alcohol). WHAT TO EXPECT DURING ENDOSCOPY Prior to the endoscopy, the staff will review your medical and surgical history, including current medications. A physician will explain the procedure and ask you to sign a consent. Before signing the consent, you should understand all the benefits and risks of the procedure, and should have all of your questions answered. An intravenous line (a needle inserted into a vein in the hand or arm) will be started to deliver medications. You will be given a combination of a sedative (to help you relax), and a narcotic (to prevent discomfort). Although most patients are sedated for the examination, many tolerate the procedure well without any medication. Your vital signs (blood pressure, heart rate, and blood oxygen level) will be monitored before, during, and after the examination. The monitoring is not painful. Oxygen is often given during the procedure through a small tube that sits under the nose and is fitted around the ears. For safety reasons, dentures should be removed before the procedure. THE ENDOSCOPY PROCEDURE The procedure typically takes between 10 and 20 minutes to complete. The endoscopy is performed while you lie on your left side. Sometimes the physician will give a medication to numb the throat (either a gargle or a spray). A plastic mouth guard is placed between the teeth to prevent damage to the teeth and scope.

The endoscope (also called a gastroscope) is a flexible tube that is about the size of a finger. The scope has a lens and a light source that allows the endoscopist to look into the scope to see the inner lining of the upper gastrointestinal tract, or to view it on a TV monitor. Most people have no difficulty swallowing the flexible gastroscope as a result of the sedating medications. Many people sleep during the test; others are very relaxed and generally not aware of the examination. An alternative procedure called transnasal endoscopy may be available in some facilities. This involves passing a very thin scope (about the size of a drinking straw) through the nose. You are not sedated but a medication is applied to the nose to prevent discomfort. A full examination can be performed with this instrument. The endoscopist may take tissue samples called biopsies (not painful), or perform specific treatments (such as dilation, removal of polyps, treatment of bleeding), depending upon what is found during the examination. Air is introduced through the scope to open the esophagus, stomach, and intestine, allowing the scope to be passed through these structures and improving the endoscopist's ability to see all of the structures. You may experience a mild discomfort as air is pushed into the intestinal tract. This is not harmful and belching may relieve the sensation. The endoscope does not interfere with breathing. Taking slow, deep breaths during the procedure may help you to relax. ENDOSCOPY RECOVERY After the endoscopy, you will be observed for one to two hours while the sedative medication wears off. The medicines cause most people to temporarily feel tired or have difficulty concentrating and you 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 usually resolves quickly. Some patients also have a mild sore throat. Most patients are able to eat shortly after the examination. ENDOSCOPY COMPLICATIONS Upper endoscopy is a safe procedure and complications are uncommon. The following is a list of possible complications: Aspiration (inhaling) of food or fluids into the lungs, the risk of which can be minimized by not eating or drinking for the recommended period of time before the examination.

The endoscope can cause a tear or hole in the tissue being examined. This is a serious complication but fortunately occurs only rarely.

Bleeding can occur from biopsies or the removal of polyps, although it is usually minimal and stops quickly on its own or can be easily controlled.

Reactions to the sedative medications are possible; the endoscopy team (doctors and nurses) will ask about previous medication allergies or reactions and about health problems such as heart, lung, kidney, or liver disease. Providing this information to the team ensures a safer examination.

The medications may produce irritation in the vein at the site of the intravenous line. If redness, swelling, or discomfort occurs, your should call your endoscopist or primary care provider, or the number given by the nurse at discharge.

The following signs and symptoms should be reported immediately: AFTER UPPER ENDOSCOPY Most patients tolerate endoscopy very well and feel fine afterwards. Some fatigue is common after the examination, and you should plan to take it easy and relax the rest of the day. The endoscopist can describe the result of their examination before you leave the endoscopy unit. If biopsies have been taken or polyps removed, you should call for results within one to two weeks. Severe abdominal pain (more than gas cramps) A firm, distended abdomen Vomiting Any temperature elevation Difficulty swallowing or severe throat pain A crunching feeling under the skin of the neck

WHERE TO GET MORE INFORMATION Your healthcare provider is the best source of information for questions and concerns related to your medical problem. This article will be updated as needed every four months on our web site (www.uptodate.com/patients). Related topics for patients, as well as selected articles written for healthcare professionals, are also available. Some of the most relevant are listed below. Patient Level Information: Patient information: Acid reflux (gastroesophageal reflux disease) in adults Professional Level Information: Antibiotic prophylaxis for gastrointestinal endoscopic procedures Autofluorescence endoscopy for Barrett's esophagus Endoscope disinfection Endoscopic diagnosis of inflammatory bowel disease Endoscopic management of pseudocysts of the pancreas: Efficacy and complications Endoscopic management of pseudocysts of the pancreas: Technique Endoscopic procedures in patients with disorders of hemostasis Magnification endoscopy Overview of deep small bowel enteroscopy Overview of procedural sedation for gastrointestinal endoscopy Role of propofol and options for patients who are difficult to sedate for gastrointestinal endoscopy Sedation-free gastrointestinal endoscopy The following organizations also provide reliable health information. National Library of Medicine

(www.nlm.nih.gov/medlineplus/healthtopics.html) (www.askasge.org) The American Society of Gastrointestinal Endoscopy:

National Institute of Diabetes and Digestive and Kidney Diseases

(http://digestive.niddk.nih.gov/ddiseases/pubs/upperendoscopy/index.htm) The author would like to acknowledge Maryanne Barretti, RN, Nurse Manager of Endoscopy at Mount Sinai Hospital, for her advice and critical input. [1-6] Last literature review version 19.2: May 2011 This topic last updated: September 16, 2008 (More)

Find Print Email The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use (click here) 2011 UpToDate, Inc.

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1. Carpenter-Aquino, A. SGNA Gastroenterology Nursing, A Core Curriculum, 4th ed, 2008. 2. Kielty LA. An investigation into the information received by patients undergoing a gastroscopy in a large teaching hospital in Ireland. Gastroenterol Nurs 2008; 31:212. 3. Ford AC, Moayyedi P. Current guidelines for dyspepsia management. Dig Dis 2008; 26:225. 4. Cho S, Arya N, Swan K, et al. Unsedated transnasal endoscopy: a Canadian experience in daily practice. Can J Gastroenterol 2008; 22:243. 5. Standards of Practice Committee, Zuckerman MJ, Shen B, et al. Informed consent for GI endoscopy. Gastrointest Endosc 2007; 66:213. 6. Lazzaroni M, Bianchi Porro G. Preparation, premedication, and surveillance. Endoscopy 2005; 37:101.
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Upper Endoscopy
Preparing for an Upper GI Endoscopy

Upper GI Endoscopy

Before the Procedure During the procedure After the Procedure

Upper GI Endoscopy The term "endoscopy" refers to a special technique for looking inside a part of the body. Upper GI is the portion of the gastro-intestinal tract, the digestive system, that includes the esophagus, the stomach, and the duodenum, the beginning of the small intestine. The esophagus carries food from the mouth for digestion in the stomach and small intestine. Upper GI endoscopy is a procedure performed by a gastroenter-ologist, a well-trained specialist who uses the endoscope to diagnose and, in some cases, treat problems of the upper digestive system. The endoscope is a long, thin, flexible tube with a tiny video camera and light on the end. By adjusting the various controls on the endoscope, the gastroenterologist can safely guide the instrument to carefully examine the inside lining of the upper digestive system. The high-quality picture from the endoscope is shown on a TV monitor; it gives a clear, detailed view. In many cases, upper GI endoscopy is a more precise examination than X-ray studies. Upper GI endoscopy can be helpful in the evaluation or diagnosis of various problems, including difficult or painful swallowing, pain in the stomach or abdomen, and bleeding, ulcers and tumors. Tiny instruments can be passed through an opening in the endoscope to obtain tissue samples, coagulate (stop) bleeding sites, dilate or stretch a narrowed area, or perform other treatments. Back to top Before the Procedure Regardless of why upper GI endoscopy has been recommended for you, there are important steps you can take to prepare for and participate in the procedure. Talk to Your Doctor First, be sure to give a complete list of all the medicines you are taking including any over-thecounter medications and natural supplements and any allergies to drugs or other substances. Your medical team will also want to know if you have heart, lung or other medical conditions that may need special attention before, during or after an upper GI endoscopy. It is important they know if you are taking diabetic medications or anticoagulants (sometimes called blood thinners) or have bleeding or clotting problems.

Prepare for the Test You will be given instructions in advance that will outline what you should and should not do in preparation for the upper GI endoscopy; be sure to read and follow these instructions. One very important step in preparing for upper GI endoscopy is that you should not eat or drink within eight to 10 hours of your procedure. Food in the stomach will block the view through the endoscope and it could cause vomiting. Upper GI endoscopy can be done in a hospital, an ambulatory surgery center or an outpatient office. You will be asked to sign a form, which verifies that you consent to having the procedure and that you understand what is involved. If there is anything you dont understand, ask for more information. Back to top During the procedure During the procedure, everything will be done to help you be as comfortable as possible. Your blood pressure, pulse and blood oxygen level will be carefully monitored. Your gastroenterologist may give you a sedative to help make you relaxed and drowsy, but you will remain awake enough to cooperate. You may also have your throat sprayed or be asked to gargle with a local anesthetic to help keep you comfortable as the endoscope is passed through. A supportive mouthpiece will be placed to help you keep your mouth open during the endoscopy. Once you are fully prepared, your gastroenterologist will gently maneuver the endoscope into position. As the endoscope is slowly and carefully inserted, air is introduced through it to help your gastroenterologist see better. During the procedure, you should feel little to no pain and it will not interfere with your breathing. Your gastroenterologist will use the endoscope to look closely for any problems that may require evaluation, diagnosis or treatment.

In some cases, it may be necessary to take a sample of tissue, called a biopsy, for later examination under the microscope. This, too, is a painless procedure. In other cases, the endoscope can be used to treat a problem such as active bleeding from an ulcer. Possible Complications Years of experience have proved that upper GI endoscopy is a safe procedure. Typically, it takes only 15 to 20 minutes to perform. Complications rarely occur. These include perforation, puncture of the intestinal wall that could require surgical repair, and bleeding, which could require transfusion. Again, these complications are unlikely; be sure to discuss any specific concerns you may have with your doctor. Back to top After the Procedure When your endoscopy is completed you will be cared for in a recovery area until most of the effects of the medication have worn off. You will be informed about the results of the procedure and be provided any additional information you need to know. You will be given instructions regarding how soon you can eat and drink, plus other guidelines for resuming your normal activity. Occasionally, minor problems may persist, such as mild sore throat, bloating or cramping; these should disappear in 24 hours or less. By the time you are ready to go home, youll feel more alert. Nevertheless, you should plan on resting for the remainder of the day. This means not driving, so you will need to have a family member or friend take you home. In a few days, you will hear from your gastroenterologist with additional information, such as results of the biopsy, or you may have questions you want to ask the doctor directly. Back to top

Digestive Care Specialist, Dr. Ranvir Singh, Dr. Stephen Rashbaum and Dr. Priya Ravindran in Cumming, Georgia 1505 Northside Blvd, STE 2850, Cumming GA 30041 Phone: 770-227-2222 Fax: 770-227-2220

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Are or might be pregnant. Are allergic to latex. Latex products are commonly used to administer the contrast material. If you have a latex allergy, different products will be used. Know that you are allergic to barium. Have had an upper digestive barium test (upper GI or barium swallow) recently. The preparation for a barium enema usually involves a very thorough cleansing of the large intestine, because the colon must be completely clear of stool and gas. Even a small amount of stool can affect the accuracy of the test. For 1 to 3 days before the test, you will usually be on a clear liquid diet. On the day before the test: You should drink very large amounts of noncarbonated clear liquids, unless your doctor has advised you not to. You will then take a combination of laxatives to empty your intestines. You may be asked to take a tap water enema to clean any remaining stool from your colon. On the day of the test, you may need to repeat the enema until the liquid that passes is free of any stool particles. Sometimes a rectal suppository or a commercially prepared enema, such as a Fleet enema, is used instead of a tap water enema. Talk to your doctor about any concerns you have regarding the need for this test, its risks, how it will be done, or what the results will mean. To help you understand the importance of this test, fill out the medical test information form (What is a PDF document?).

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Article Link: http://www.webmd.com/digestive-disorders/barium-enema WebMD Home Digestive Disorders Health Center Email a Friend Save Print Article Digestive Disorders Health Center Tools & Resources Digestive Myths From Gum to Gas What's Your Medication IQ? Diarrhea: Foods to Avoid 16 Tips for Good Digestion

Controlling IBS With Diet 8 Digestive Health Supplements Font size: AAA Share this: Barium Enema A barium enema, or lower gastrointestinal (GI) examination, is an X-ray examination of the large intestine (colon and rectum). The test is used to help diagnose diseases and other problems that affect the large intestine. To make the intestine visible on an X-ray picture, the colon is filled with a contrast material containing barium. This is done by pouring the contrast material through a tube inserted into the anus. The barium blocks X-rays, causing the barium-filled colon to show up clearly on the X-ray picture. There are two types of barium enemas. In a single-contrast study large abnormalities. , the colon is filled with barium, which outlines the intestine and reveals

In a double-contrast or air-contrast study , the colon is first filled with barium and then the barium is drained out, leaving only a thin layer of barium on the wall of the colon. The colon is then filled with air. This provides a detailed view of the inner surface of the colon, making it easier to see narrowed areas (strictures), diverticula, or inflammation. In some cases, the single-contrast study may be preferred for specific medical reasons or for older people who may not be able to tolerate the time-consuming and somewhat more uncomfortable double-contrast study. But if the results are not clear, a double-contrast study may also be done. Why It Is Done A barium enema is done to: Identify inflammation of the intestinal wall that occurs in inflammatory bowel diseases, such as ulcerative colitis or Crohn's disease. A barium enema also may be used to monitor the progress of these diseases. Find problems with the structure of the large intestine, such as narrowed areas (strictures) or pockets or sacs (diverticula) in the intestinal wall. Help correct a condition called ileocolic intussusception protrudes into the large intestine. , in which the end of a child's small intestine

Evaluate abdominal symptoms such as pain, blood in stool, or altered bowel habits. Evaluate other problems such as anemia or unexplained weight loss. How To Prepare Before a barium enema, tell your doctor if you: Are or might be pregnant. Are allergic to latex. Latex products are commonly used to administer the contrast material. If you have a latex allergy, different products will be used. Know that you are allergic to barium. Have had an upper digestive barium test (upper GI or barium swallow) recently. Have had a colonoscopy or sigmoidoscopy recently. The preparation for a barium enema usually involves a very thorough cleansing of the large intestine, because the colon must be completely clear of stool and gas. Even a small amount of stool can affect the accuracy of the test. For 1 to 3 days before the test, you will usually be on a clear liquid diet. On the day before the test: You should drink very large amounts of noncarbonated clear liquids, unless your doctor has advised you not to. You will then take a combination of laxatives to empty your intestines. You may be asked to take a tap water enema to clean any remaining stool from your colon. On the day of the test, you may need to repeat the enema until the liquid that passes is free of any stool particles. Sometimes a rectal suppository or a commercially prepared enema, such as a Fleet enema, is used instead of a tap water enema. Talk to your doctor about any concerns you have regarding the need for this test, its risks, how it will be done, or what the results will mean. To help you understand the importance of this test, fill out the medical test information form Further Reading: Reducing Radiation from Medical X-rays X-Ray Exams of the Digestive Tract Radiation Imaging Is Common in Children (What is a PDF document?).

Abdominal X-ray Arthrogram (Joint X-ray) Extremity X-ray Facial X-ray See All X-Rays Topics Also Recommended: Could Your Symptoms Be Lactose Intolerance? Newly Diagnosed With Crohn's? Steps to Take Diarrhea: Three Types & Their Causes Abdominal Pain: What Could Be Causing It Risky Combinations: Pain Medications and Your Stomach Is Acid Reflux Causing Your Cough? 1|2|3|4 Next Page >

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