Hi, it’s Dr. Parker again and in this article I’d like to talk about the Upper GI Endoscopy or “Stomach Scope”. This is a procedure that is very similar to the colonoscopy except it is a visual inspection of the esophagus, stomach and first portion of the small bowel. There are many reasons to have an upper endoscopy, so I’m not going to go over why your doctor has recommended it for you, but I’ll talk about the process itself.
If you have ever had a colonoscopy, the pre and post procedure portion is nearly the same. Fortunately, the upper endoscopy does not require a bowel preparation, but it does require fasting from midnight the night before your procedure. You should not have anything by mouth from midnight before the procedure until after the scope is finished. If you take blood pressure medication, talk to your doctor (or the physician performing the scope) about if you should take that medication with a sip of water the morning of the procedure. Different people will require different answers to that question, so it’s best to have that discussion before hand.
You should arrive at the outpatient pre-operative area of the facility in which you are having the procedure done 1 hour prior to your procedure time. You will change into a hospital gown and be asked to remove jewelry. You will have an IV placed and the anesthesiologist will talk to you about the risks of the sedation specific to you. The physician performing the procedure will also talk to you before the examination to answer any last-minute questions you may have. After this is done, you will be taken to the endoscopy suite and placed on your left side. Any dentures will be removed at this point. A numbing spray is used to numb the back of your throat. We also place a protective device in your mouth to protect your teeth from the scope an the scope from your teeth.
The upper endoscopy is then performed with a long thin flexible camera that is able to be maneuvered with a hand control through the esophagus, stomach and duodenum (first portion of the small bowel) after being inserted through the mouth. This is done after you are sedated. During the upper endoscopy you are able to breath on your own and follow some simple commands, however, the sedation is such that you will not remember the examination.
The doctor will maneuver the camera while watching the projected image on TV screen. The doctor advances the camera to the first portion of the small bowel (also called the duodenum, which is located on the right side of the abdomen). The doctor then withdraws the camera slowly, inspecting the lining of the duodenum, stomach and esophagus. The magnification the camera provides allows the doctor to inspect the lining of the gastrointestinal tract for abnormalities.
Depending on the reason for your upper endoscopy, the doctor may perform a biopsy (remove a sample of the lining of the esophagus, stomach or duodenum) if needed. There are several other diagnostic and therapeutic techniques that can be used depending on your situation, but the biopsy is the most common.
Just like all medical and surgical procedures, there are risks associated with the upper endoscopy as well. The major risks include, bleeding, injury to the GI tract, missed pathology and incomplete examination.
Most bleeding is self limiting (it stops on it’s own), but sometimes the upper endoscopy is being done to stop bleeding and can be unsuccessful, or during a diagnostic or therapeutic maneuver a blood vessel is injured and can continue bleeding. Bleeding can be mild to severe, with treatment ranging from observation to blood transfusion to another endoscopy and very rarely, surgery.
A very small percentage of patients who undergo upper endoscopy can have an injury to the esophagus, stomach or duodenum. By injury I mean a hole is inadvertently put in one of these organs. If this happens, you will require an operation to fix that hole. Fortunately this does not happen often and your doctor should be able to tell you your specific risk as all patients do not have the same risk of organ injury.
Sometimes during the upper endoscopy, the physician is not able to maneuver the scope to complete the exam. In addition, sometimes we flat out miss things. Either way, though these don’t seem like real “risks”, I like to include them when discussing upper endoscopy with my patients because if we miss something that is causing your problem, this problem could persist and even get worse. Fortunately, in this exam, these are low risks.
Well now that’ I’ve told you all about the doom and gloom of the procedure, I’ll leave you with something more positive. Most upper endoscopy examinations are fairly quick, anywhere from 10-30 minutes, and as soon as you are awake and alert you can stop fasting and eat! See, this scope stuff isn’t all bad. 🙂