Upper Gastrointestinal Endoscopy

An upper gastrointestinal (UGI) endoscopy is a procedure that allows your doctor to look at the inside lining of
your esophagus , yourstomach, and the first part of your small intestine (duodenum ). A thin, flexible viewing tool
called an endoscope (scope) is used. The tip of the scope is inserted through your mouth and then gently moved
down your throat into the esophagus, stomach, and duodenum (upper gastrointestinal tract).

This procedure is sometimes called esophagogastroduodenoscopy (EGD).

Using the scope, your doctor can look for ulcers, inflammation, tumors, infection, or bleeding. He or she can collect
tissue samples (biopsy), remove polyps, and treat bleeding through the scope. Your doctor may find problems that do
not show up on X-ray tests.

This test can sometimes prevent 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:
 Inflammation of the esophagus (esophagitis ) or the stomach (gastritis).
 Gastroesophageal reflux disease (GERD).
 A narrowing (stricture) of the esophagus.
 Enlarged and swollen veins in the esophagus or stomach. (These veins are called varices.)
 Barrett's esophagus, a condition that increases the risk foresophageal cancer.
 Hiatal hernia.
 Ulcers.
 Cancer.
Find the cause of vomiting blood.
Find the cause of symptoms, such as upper belly 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.
Endoscopy may also be done to:

 Check for an injury to the esophagus in an emergency. (For example, this may be done if the person has swallowed
poison.)
 Collect tissue samples (biopsy) to be looked at in the lab.
 Remove growths (polyps) from inside the esophagus, stomach, or small intestine.
 Treat upper GI bleeding that may be causing anemia.
 Remove foreign objects that have been swallowed.

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 aswarfarin (Coumadin).
 Have heart problems.
 Are or might be pregnant.
 Have diabetes and take insulin.
 Have had surgery or radiation treatments to your esophagus, your stomach, or the upper part of your small intestine.

How To Prepare continued...

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 the vomit could
enter your lungs. (This is called 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 about 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.

You may be asked to stop taking aspirin products, nonsteroidal anti-inflammatory drugs (NSAIDs), and iron
supplements 7 to 14 days before the test. If you take blood-thinning medicines regularly, talk with your doctor about
how to manage your medicine.

Do not take sucralfate (Carafate) or antacids on the day of the test. These medicines can make it hard for your doctor
to see your upper GI tract.

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.

Arrange to have someone take you home after the test. You will be given a sedative before the test and will need a
ride home.

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 isn't needed. The test is most often done by a doctor who specializes in problems of the digestive
system (gastroenterologist). The doctor may also have an assistant. Some family medicine doctors, internists,
andsurgeons are also trained to do this test.

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. This is to relax your gag reflex and make it easier to insert
the endoscope into your throat.

How It Is Done continued...

During the test, you may get 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 yourteeth from the endoscope (scope). Then the lubricated tip of the scope will be guided into your
mouth. Your doctor may gently press yourtongue out of the way. You may be asked to swallow to help move the tube
along. The scope is no thicker than many foods you swallow. It will not cause problems with breathing.

After the scope 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 you are asked to. Someone 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 look through an eyepiece or watch a screen while he or she slowly moves the endoscope. The doctor
will check 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. Suction may be applied to remove air or secretions.

A camera attached to the scope takes pictures. The doctor may also insert tiny tools such as forceps, clips, and
swabs through the scope to collect tissue samples (biopsy), remove growths, or stop bleeding.

To make it easier for your doctor to see different parts of your upper gastrointestinal (GI) tract, someone may change
your position or apply gentle pressure to your belly. After the exam is done, the scope 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.
Tests and Procedures

Upper endoscopy

Definition
An upper endoscopy is a procedure used to visually examine your upper digestive system with
a tiny camera on the end of a long, flexible tube. A specialist in diseases of the digestive
system (gastroenterologist) uses an endoscopy to diagnose and, sometimes, treat conditions
that affect the esophagus, stomach and beginning of the small intestine (duodenum).

The medical term for an upper endoscopy is esophago-gastroduodenoscopy. You may have an
upper endoscopy done in your doctor's office, an outpatient surgery center or a hospital.

Why it's done

An upper endoscopy is used to diagnose and, sometimes, treat conditions that affect the
upper part of your digestive system, including the esophagus, stomach and beginning of the
small intestine (duodenum).

Your doctor may recommend an endoscopy procedure to:

 Investigate symptoms. An endoscopy may help your doctor determine what's causing
digestive signs and symptoms, such as nausea, vomiting, abdominal pain, difficulty
swallowing and gastrointestinal bleeding.
 Diagnose. Your doctor may use an endoscopy to collect tissue samples (biopsy) to test for
diseases and conditions, such as anemia, bleeding, inflammation, diarrhea or cancers of
the digestive system.
 Treat. Your doctor can pass special tools through the endoscope to treat problems in your
digestive system, such as burning a bleeding vessel to stop bleeding, widening a narrow
esophagus, clipping off a polyp or removing a foreign object.
An endoscopy is sometimes combined with other procedures, such as an ultrasound. An
ultrasound probe may be attached to the endoscope to create specialized images of the wall
of your esophagus or stomach. An endoscopic ultrasound may also help your doctor create
images of hard-to-reach organs, such as your pancreas. Newer endoscopes use high-definition
video to provide clearer images.
Many endoscopes allow your doctor to use technology called narrow band imaging, which
uses special light to help better detect precancerous conditions, such as Barrett's esophagus.

Risks
An endoscopy is a very safe procedure. Rare complications include:

 Bleeding. Your risk of bleeding complications after an endoscopy is increased if the

procedure involves removing a piece of tissue for testing (biopsy) or treating a digestive
system problem. In rare cases, such bleeding may require a blood transfusion.
 Infection. Most endoscopies consist of an examination and biopsy, and risk of infection is
low. The risk of infection increases when additional procedures are performed as part of
your endoscopy. Most infections are minor and can be treated with antibiotics. Your doctor
may give you preventive antibiotics before your procedure if you are at higher risk of
infection.
 Tearing of the gastrointestinal tract. A tear in your esophagus or another part of your upper
digestive tract may require hospitalization, and sometimes surgery to repair it. The risk of
this complication is very low — it occurs in an estimated 1 of every 2,500 to 11,000
diagnostic upper endoscopies. The risk increases if additional procedures, such as dilation
to widen your esophagus, are performed.
You can reduce your risk of complications by carefully following your doctor's instructions for
preparing for an endoscopy, such as fasting and stopping certain medications.

Signs and symptoms that could indicate a complication

Signs and symptoms to watch for after your endoscopy include:

 Fever
 Chest pain
 Shortness of breath
 Bloody, black or very dark colored stool
 Difficulty swallowing
 Severe or persistent abdominal pain
 Vomiting, especially if your vomit is bloody or looks like coffee grounds
Call your doctor immediately or go to an emergency room if you experience any of these signs
or symptoms.

How you prepare

Your doctor will give you specific instructions to prepare for your endoscopy. In some cases
your doctor may ask that you:

 Fast before the endoscopy. You will need to stop drinking and eating four to eight hours
before your endoscopy to ensure your stomach is empty for the procedure.
 Stop taking certain medications. You will need to stop taking certain blood-thinning
medications in the days before your endoscopy. Blood thinners may increase your risk of
bleeding if certain procedures are performed during the endoscopy. If you have chronic
conditions, such as diabetes, heart disease or high blood pressure, your doctor will give you
specific instructions regarding your medications.
Tell your doctor about all the medications and supplements you're taking before your
endoscopy.

Plan ahead for your recovery

Most people undergoing an upper endoscopy will receive a sedative to relax them and make
them more comfortable during the procedure. Plan ahead for your recovery while the sedative
wears off. You may feel mentally alert, but your memory, reaction times and judgment may be
impaired. Find someone to drive you home. You may also need to take the day off from work.
Don't make any important personal or financial decisions for 24 hours.

What you can expect

During an endoscopy
During an upper endoscopy procedure, you'll be asked to lie down on a table on your back or
on your side. As the procedure gets underway:

 Monitors often will be attached to your body. This will allow your health care team to
monitor your breathing, blood pressure and heart rate.
 You may receive a sedative medication. This medication, given through a vein in your
forearm, helps you relax during the endoscopy.
 Your doctor may spray an anesthetic in your mouth. This medication will numb your throat
in preparation for insertion of the long, flexible tube (endoscope). You may be asked to
wear a plastic mouth guard to hold your mouth open.
 Then the endoscope is inserted in your mouth. Your doctor may ask you to swallow as the
scope passes down your throat. You may feel some pressure in your throat, but you
shouldn't feel pain.
You can't talk after the endoscope passes down your throat, though you can make noises. The
endoscope doesn't interfere with your breathing.

As your doctor passes the endoscope down your esophagus:

 A tiny camera at the tip transmits images to a video monitor in the exam room. Your doctor
watches this monitor to look for abnormalities in your upper digestive tract. If
abnormalities are found in your digestive tract, your doctor may record images for later
examination.
 Gentle air pressure may be fed into your esophagus to inflate your digestive tract. This
allows the endoscope to move freely. And it allows your doctor to more easily examine the
folds of your digestive tract. You may feel pressure or fullness from the added air.
 Your doctor will pass special surgical tools through the endoscope to collect a tissue
sample or remove a polyp.Your doctor watches the video monitor to guide the tools.
When your doctor has finished the exam, the endoscope is slowly retracted through your
mouth. An endoscopy typically takes 15 to 30 minutes, depending on your situation.

After the endoscopy

You'll be taken to a recovery area to sit or lie quietly after your endoscopy. You may stay for
an hour or so. This allows your health care team to monitor you as the sedative begins to wear
off.

Once you're at home, you may experience some mildly uncomfortable signs and symptoms
after endoscopy, such as:

 Bloating and gas

 Cramping
 Sore throat
These signs and symptoms will improve with time. If you're concerned or quite uncomfortable,
call your doctor.

Take it easy for the rest of the day after your endoscopy. After receiving a sedative, you may
feel alert, but your reaction times are affected and judgment is delayed.

Results
When you receive the results of your endoscopy will depend on your situation. If, for instance,
your doctor performed the endoscopy to look for an ulcer, you may learn the findings right
after your procedure. If he or she collected a tissue sample (biopsy), you may need to wait a
few days to get results from the testing laboratory. Ask your doctor when you can expect the
results of your endoscopy.

Pathophysiology
Esophagus
Most complications of pediatric foreign body ingestion are due to esophageal impaction, usually at 1 of 3
typical locations. The most common site of esophageal impaction is at the thoracic inlet. Defined as the
area between the clavicles on chest radiograph, this is the site of anatomical change from the skeletal
muscle to the smooth muscle of the esophagus. The cricopharyngeus sling at C6 is also at this level and
may "catch" a foreign body. About 70% of blunt foreign bodies that lodge in the esophagus do so at this
location. Another 15% become lodged at the mid esophagus, in the region where the aortic arch and
carina overlap the esophagus on chest radiograph. The remaining 15% become lodged at the lower
esophageal sphincter (LES) at the gastroesophageal junction.
Children with preexisting esophageal abnormalities (eg, repair of a tracheoesophageal fistula) are likely to
have foreign body impaction at the site of the abnormality. If a child with no known esophageal pathology
has a blunt foreign body lodged at a location other than the 3 typical locations described above, the
possibility of a previously unknown esophageal abnormality should be considered. The presence of
eosinophilic esophagitis has been recognized as contributing to adult esophageal foreign body impaction
and may be its presenting feature; although less common in children, eosinophilic esophagitis has also
been associated with pediatric esophageal food impaction.[1]
Pointed objects, such as thumbtacks, may become impaled and, therefore, lodged anywhere in the
esophagus. Small objects, such as pills and smaller button batteries, may adhere to the slightly moist
esophageal mucosa at any point.
Stomach/lower gastrointestinal tract
Once a swallowed foreign body reaches the stomach of a child with a normal GI tract, it is much less
likely to lead to complications. Foreign bodies occasionally become lodged at the ileocecal valve.[2] Coins
made largely from zinc, most notable United States cents, have been reported to interact with stomach
acid leading to stomach ulceration.[3] Foreign-body — induced appendicitis has been reported.[4] Other
exceptions include pointed or toxic foreign bodies or objects too long (ie, >6 cm) or too wide (ie, >2 cm) to
pass through the pyloric sphincter.
Another important exception is the child who has swallowed more than one magnet; reports exist of
swallowed toy magnets attracting and adhering tightly to each other through the GI tract, leading to small
bowel obstruction or necrosis of intervening tissues, sometimes with severe sequelae.[5, 6, 7] Magnets may
also attract other ferrous swallowed foreign bodies, causing similar problems.
Children with known GI tract abnormalities are more likely to encounter complications. Previous surgery
may cause abnormalities of peristalsis, increasing the likelihood of foreign body impaction. For example,
children who have had surgery to correct pyloric stenosis are more likely to retain a foreign body in the
stomach.
Previously unsuspected lower GI tract abnormalities may present as a complication of foreign body
ingestion. For example, a small foreign body may become lodged in a Meckel diverticulum.
Impacted foreign bodies
A foreign body lodged in the GI tract may have little or no effect; cause local inflammation leading to pain,
bleeding, scarring, and obstruction; or erode through the GI tract. Migration from the esophagus most
often leads to mediastinitis but may involve the lower respiratory tract or aorta and create an aortoenteric
fistula. Migration through the lower GI tract may cause peritonitis.
If you swallow a foreign object, it will usually pass through your digestive system uneventfully.
But some objects can lodge in your esophagus, the tube that connects your throat and
stomach. If an object is stuck in your esophagus, you may need to have it removed, especially
if it is:

 A pointed object, which should be removed as quickly as possible to avoid further injury to
the esophageal lining
 A tiny watch- or calculator-type button battery, which can rapidly cause nearby tissue
injury and should be removed from the esophagus without delay
If a person who has swallowed an object is coughing forcefully, encourage him or her to
continue coughing and do not interfere. If a swallowed object blocks the airway and the
person's condition worsens — the cough becomes silent or breathing becomes more difficult
— the American Red Cross recommends the five-and-five approach to first aid:

 Give 5 back blows. First, deliver five back blows between the person's shoulder blades
with the heel of your hand.
 Give 5 abdominal thrusts. Perform five abdominal thrusts (also known as the Heimlich
maneuver). Abdominal thrusts may injure infants. Use chest compressions instead.
 Alternate between 5 back blows and 5 abdominal thrustsuntil the blockage is dislodged.
If you're the only rescuer, perform back blows and abdominal thrusts before calling 911 or
your local emergency number for help. If another person is available, have that person call for
help while you perform first aid.

If the person becomes unconscious, help him or her to the ground and begin CPR. After
attempted rescue breaths, check the mouth for an object and if visible remove it. Do not
perform a blind finger sweep because this could push an object farther into the airway.

The American Heart Association does not teach the back-blow technique, only the abdominal
thrust procedures. It's OK not to use back blows if you have not learned the back-blow
technique. Both approaches are acceptable.

To perform the Heimlich maneuver on someone else

 Stand behind the person. Wrap your arms around the waist. Tip the person forward slightly.
 Make a fist with 1 hand. Position it slightly above the person's navel.
 Grasp the fist with the other hand. Press hard into the abdomen with a quick, upward
thrust — as if trying to lift the person up.
 Perform a total of 5 abdominal thrusts, if needed. If the blockage still isn't dislodged,
repeat the five-and-five cycle.
A modified version of the technique is sometimes taught for use with pregnant or obese
people. The rescuer places his or her hand in the center of the chest to compress, rather than
in the abdomen.

To perform the Heimlich maneuver on yourself

If you're choking and alone, call 911 or your local emergency number immediately. You can't
perform back blows on yourself. But you can perform abdominal thrusts.
 Place a fist slightly above your navel.
 Grasp your fist with the other hand and bend over a hard surface — a countertop or chair
will do.
 Shove your fist inward and upward.