Test Overview
An upper gastrointestinal (UGI) endoscopy is
a procedure that allows your doctor to look at the interior lining of your
esophagus, your stomach, and the first part of your
small intestine (duodenum) through a thin, flexible
viewing instrument called an endoscope. The tip of the endoscope is inserted
through your mouth and then gently moved down your throat into the esophagus,
stomach, and duodenum (upper gastrointestinal tract).
Since the
entire upper gastrointestinal (GI) tract can be examined during this test, the
procedure is sometimes called esophagogastroduodenoscopy (EGD).
Using the endoscope, your doctor can look for
ulcers, inflammation, tumors, infection, or bleeding.
Tissue samples can be collected (biopsy),
polyps can be removed, and bleeding can be treated
through the endoscope. Endoscopy can reveal problems that do not show up on
X-ray tests, and it can sometimes eliminate the need for exploratory
surgery.
Why It Is Done
An upper gastrointestinal (UGI) endoscopy may be done to:
- Find problems in the upper gastrointestinal
(GI) tract. These problems can include:
- Find the cause of vomiting blood
(hematemesis).
- Find the cause of symptoms, such as upper abdominal
pain or bloating, trouble swallowing (dysphagia), vomiting, or
unexplained weight loss.
- Find the cause of an
infection.
- Check the healing of stomach ulcers.
- Look
at the inside of the stomach and upper small intestine (duodenum) after
surgery.
- Look for a blockage in the opening between the stomach and
duodenum (gastric outlet obstruction).
Endoscopy may also be done to:
- Check for an esophageal injury in an emergency
(for example, if the person has swallowed poison).
- Collect tissue
samples (biopsy) for examination in the laboratory.
- Remove growths
from inside the esophagus, stomach, or small intestine (gastrointestinal
polyps).
- Treat upper gastrointestinal bleeding, including bleeding
caused by engorged veins in the esophagus (esophageal
varices).
- Remove foreign objects that have been
swallowed.
- Look for bleeding that may be causing a decrease in the
amount of oxygen-carrying substance (hemoglobin) found in red blood cells
(anemia).
How To Prepare
Before having an upper
gastrointestinal endoscopy, tell your doctor if you:
- Are allergic to any medicines, including
anesthetics.
- Are taking any medicines.
- Have bleeding
problems or take blood-thinning medicine, such as warfarin (Coumadin).
- Have heart problems.
- Are or might be
pregnant.
- Have
diabetes and take insulin.
- Have had
surgery or radiation treatments to your esophagus, stomach, or the upper part
of your small intestine.
Do
not eat or drink anything for 6 to 8 hours before the test. An empty stomach
helps your doctor see your stomach clearly during the test. It also reduces
your chances of vomiting. If you vomit, there is a small risk that your stomach
contents could enter your lungs (aspiration). If the test is done in an
emergency, a tube may be inserted through your nose or mouth to empty your
stomach.
You may be asked to sign a consent form that says you understand the risks of the test and agree to have it done.
Talk to your doctor about any concerns you have regarding the need for
the 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?).
You may be asked to stop taking
aspirin products or iron supplements 7 to 14 days before the test. If you take
blood-thinning medicines regularly, discuss with your doctor how to manage your
medicine.
Do not take sucralfate (Carafate) or antacids on the day of
the test. These medicines can interfere with your doctor's ability to view the
gastrointestinal tract.
If biopsy samples are taken or polyps are
removed during the test, bleeding may also occur. This bleeding usually stops
on its own without treatment. To reduce this risk, avoid aspirin and
nonsteroidal anti-inflammatory drugs (NSAIDs) for
several days before the endoscopy. If you take blood-thinning medicine, you may
be instructed to stop the medicine temporarily before the test.
Before the test, you will put on a hospital gown. If you
are wearing dentures, jewelry, contact lenses, or glasses, remove them. For
your own comfort, empty your bladder before the test begins.
Arrange to have someone take you home after the test because you will be
given a sedative before the test.
How It Is Done
A gastrointestinal endoscopy may be
done in a doctor's office, a clinic, or a hospital. An overnight stay in the
hospital usually is not needed. The test is most often performed by a doctor
who specializes in problems of the digestive system (gastroenterologist). The doctor may also have an
assistant. Some
family medicine doctors,
internists, and
surgeons are also trained to do endoscopy.
Before the procedure, blood tests may be done to check for a low blood
count or clotting problems. Your throat may be numbed with an anesthetic spray,
gargle, or lozenge to relax your gag reflex and make it easier to insert the
endoscope into your throat.
During the
test, you may receive a pain medicine and a
sedative through an intravenous (IV) line in your arm
or hand. These medicines reduce pain and will make you feel relaxed and
drowsy during the test. You may not remember much about the actual test.
You will be asked to lie on your left side with your head bent
slightly forward. A mouth guard may be placed in your mouth to protect your
teeth from the endoscope. Then the lubricated tip of the endoscope will be
guided into your mouth, and your doctor may gently press your tongue out of the
way. You may be asked to swallow to help move the tube along. It is helpful to
remember that the instrument is no thicker than many foods you swallow and will
not cause problems with breathing.
Once the endoscope is in your
esophagus, your head will be tilted upright. This makes it easier for the scope
to slide down your esophagus. During the procedure, try not to swallow unless
requested to. An assistant may remove the saliva from your mouth with a suction
device, or you can allow the saliva to drain from the side of your mouth.
Your doctor will slowly move the endoscope while looking
through an eyepiece or watching on a video monitor to examine the walls of your
esophagus, stomach, and duodenum. Air or water may be injected through the
scope to help clear a path for the scope or to clear its lens, and suction may
be applied to remove air or secretions.
A camera attached to the
endoscope takes pictures for viewing on the monitor and stores some pictures
for later study. The doctor may also insert tiny instruments (forceps, loops,
swabs) through the endoscope to collect tissue samples (biopsy) or remove
growths. The biopsy test is completely painless.
To make it easier
for your doctor to see different parts of your upper gastrointestinal (GI)
tract, you may be repositioned or have gentle pressure applied to your belly.
When the examination is completed, the endoscope is slowly withdrawn.
After the test
The test usually takes 30 to 45
minutes, but it may take longer, depending upon what is found and what is done
during the test.
After the test, you will be observed for 1 to 2
hours until the medicines wear off. If your throat was numbed before the
test, you should not eat or drink until your throat is no longer numb and your
gag reflex has returned to normal.
When you are fully recovered,
you can go home. You will not be able to drive or operate machinery for 12
hours after the test. Your doctor will tell you when you can resume your usual
diet and activities. Do not drink alcohol for 12 to 24 hours after the test.
How It Feels
You may notice a brief, sharp pain when
the intravenous (IV) needle is placed in a vein in your arm. The
local anesthetic sprayed into your throat usually
tastes slightly bitter and will make your tongue and throat feel numb and
swollen. Some people report that they feel as if they cannot breathe at times
because of the tube in their throat, but this is a false sensation caused by
the anesthetic. There is always plenty of breathing space around the tube in
your mouth and throat. Remember to relax and take slow, deep breaths.
During the test, you may feel very drowsy and relaxed from the sedative
and pain medicines. You may have some gagging, nausea, bloating, or mild
abdominal cramping as the tube is moved. If you are having pain, alert your
doctor with an agreed-upon signal or a tap on the arm. Even though you won't be
able to talk during the procedure, you can still communicate.
The
suction machine used to remove secretions may be noisy but does not cause pain.
The removal of biopsy samples is also painless.
You will feel
groggy after the test until the medicine wears off, usually in a few hours.
Many people report that they remember very little of the test because of the
sedative given before and during the test.
After the test, you may
belch and feel bloated for a while. You may also have a tickling, dry throat or mouth;
slight hoarseness; or a mild sore throat. These symptoms may last several days.
Throat lozenges and warm saltwater gargles can help relieve the throat
symptoms. Do not drink alcohol after the test.
Risks
Complications from gastrointestinal endoscopy
are rare. There is a slight risk of puncturing your throat (esophagus),
stomach, or upper small intestine (duodenum). If this happens, you may need to
have surgery to fix it. There is also a slight chance of infection after an
endoscopy.
Bleeding may also occur from the test or if a tissue
sample (biopsy) is taken, but this usually stops on its own without treatment.
If you vomit during the examination and some of the material you vomit enters
your lungs,
aspiration pneumonia is a possible risk. If it
develops, it can be treated with antibiotics.
An irregular
heartbeat may occur during the test but nearly always subsides on its own
without treatment.
The procedure has more risk for people with
serious heart disease, older adults, and those who are frail or physically
weakened. Although complications are rare, you should discuss your specific
risks with your doctor.
After the test
After the test, call 911 or other emergency services immediately if you develop:
After the test, call your doctor immediately if
you:
- Feel short of breath or
dizzy.
- Have symptoms of infection, such as fever or chills.
- Vomit blood, whether it is fresh and red or is old and looks
like coffee grounds.
Results
An upper gastrointestinal (UGI)
endoscopy is a procedure that allows your doctor to look at the interior lining
of your esophagus, your stomach, and the first part of your small intestine
(duodenum) through a thin, flexible viewing instrument
called an endoscope.
Your doctor may be able to talk to you about
some of the findings with you immediately after your upper gastrointestinal
endoscopy. But the medicines given to help relax you may impair your
memory, so your doctor may wait until they wear off completely. Other
results are usually available in 2 to 4 days. Tests for certain infections may
take several weeks.
Upper gastrointestinal endoscopy
| Normal: |
The esophagus, stomach, and upper small
intestine (duodenum) look normal.
|
| Abnormal: |
Inflammation or irritation is found in the
esophagus (esophagitis), stomach (gastritis), or small intestine.
|
|
Bleeding, an ulcer, a tumor, a tear, or
dilated veins (esophageal varices) are found in the esophagus, stomach, or
duodenum.
|
|
A
hiatal hernia is found.
|
|
A too-narrow (stricture) section is found in
the esophagus.
|
|
A foreign object is found in
the esophagus, stomach, or duodenum.
|
A biopsy sample may be taken to:
- Find out if tumors or ulcers contain cancer
cells.
- Identify a type of bacteria called
Helicobacter pylori (H. pylori).
Many conditions can change the results of an upper
gastrointestinal endoscopy. Your doctor will talk with you about any abnormal
results that may be related to your symptoms and past health.
What Affects the Test
You may not be able to
have the test or the results may not be helpful if you just had another test that uses barium
contrast material. An upper gastrointestinal endoscopy
should not be done less than 2 days after you have an upper gastrointestinal
(GI) series so your doctor can see your stomach and small
intestine.
What To Think About
- An upper gastrointestinal endoscopy is the best
way to examine your esophagus, stomach, and upper small intestine (duodenum).
Your doctor can take a tissue sample to test for Helicobacter pylori infection, which is believed to be the main cause of stomach or
duodenal ulcers. To learn more, see the topic Helicobacter Pylori Tests.
- Cancer can be identified or ruled out using endoscopy.
- Endoscopy may be done after an upper gastrointestinal series test
identifies a problem. To learn more, see the topic Upper Gastrointestinal Series.
- Endoscopy
can be safely performed on small children.
- Endoscopic retrograde cholangiopancreatogram (ERCP) is a test of the ducts that drain the liver,
gallbladder, and
pancreas. It can be done to find the cause of
jaundice if your doctor thinks you may have blockage
of the bile or pancreatic ducts and when other tests (such as
ultrasound, liver scan, and X-ray studies) are not
clear. To learn more, see the topic Endoscopic Retrograde Cholangiopancreatogram (ERCP).
References
Other Works Consulted
- Chernecky CC, Berger BJ (2008). Laboratory Tests and Diagnostic Procedures, 5th ed. St. Louis:
Saunders.
- Fischbach FT, Dunning MB III, eds. (2009).
Manual of Laboratory and Diagnostic Tests, 8th ed.
Philadelphia: Lippincott Williams and Wilkins.
- Pagana KD, Pagana TJ (2010). Mosby’s Manual of Diagnostic and Laboratory Tests, 4th ed. St. Louis: Mosby Elsevier.
Credits
|
By
|
Healthwise Staff |
|
Primary Medical Reviewer
|
E. Gregory Thompson, MD - Internal Medicine |
|
Specialist Medical Reviewer
|
Jerome B. Simon, MD, FRCPC, FACP - Gastroenterology |
|
Last Revised
|
March 7, 2012 |