Upper Endoscopy (Esophagogastroduodenoscopy, EGD

What is upper endoscopy?

Upper endoscopy is a procedure that enables the examiner (usually a gastroenterologist) to examine the esophagus (swallowing tube), stomach, and duodenum (first portion of small bowel) using a thin, flexible tube through which the lining of the esophagus, stomach, and duodenum can be viewed using a TV monitor.

How do I prepare for endoscopy?

To accomplish a safe and complete examination, the stomach should be empty. The patient will most likely be asked to have nothing to eat or drink for six hours or more prior to the procedure.
Prior to scheduling the procedure, the patient should inform his or her physician of any medications they are currently taking, any allergies, and all of their health problems. This information will remind the doctor whether the patient may need antibiotics prior to the procedure, what potential medications should not be used during the exam because of the patient's allergies, and will provide the individual scheduling the procedure an opportunity to instruct the patient whether any of the medications they are taking should be held or adjusted prior to the endoscopy.
Knowledge whether the patient has any major health problems, such as heart or lung diseases, will alert the examiner of possible need for special attention during the procedure.

Why have you been scheduled for an endoscopy?

Upper endoscopy usually is performed to evaluate possible problems with the esophagus, stomach or duodenum, and evaluate symptoms such as upper abdominal pain, nausea or vomiting, difficulty in swallowing, intestinal bleeding anemia, etc.. Upper endoscopy is more accurate than X-ray for detecting inflammation or smaller abnormalities such as ulcers or tumors within the reach of the instrument. Its other major advantage over X-ray is the ability to perform biopsies (obtain small pieces of tissue) or cytology (obtain some cells with a fine brush) for microscopic examination to determine the nature of the abnormality and whether the abnormality is benign or malignant (cancerous).
Biopsies are taken for many reasons and may not mean that cancer is suspected. Upper endoscopy also can be used to treat many conditions within its reach. The endoscope's channels permit passage of accessory instruments enabling the examiner to treat many of the conditions such as stretching areas of narrowing (strictures), removal of benign growths such as polyps, accidentally swallowed objects, or treating upper gastrointestinal bleeding as seen in ulcers tears of the lining. These capabilities have markedly reduced the need for transfusions or surgery.

What can I expect during endoscopy?

It is most likely that before the procedure the doctor will discuss with the patient why the procedure is being done, whether there are alternative procedures or tests, and what possible complications may result from the endoscopy. Practices vary amongst physicians but the patient may have the throat sprayed with a numbing solution and will probably be given a sedating and pain alleviating medication through the vein. While lying on your left side the flexible endoscope, the thickness of a small finger, is passed through the mouth into the esophagus, stomach, and duodenum. This procedure will NOT interfere with your breathing. Most patients experience only minimal discomfort during the test and many sleep throughout the entire procedure.

What happens after the endoscopy?

After the test the patient will be observed and monitored by a qualified individual in the endoscopy or a recovery area until a significant portion of the medication has worn off. Occasionally a patient is left with a mild sore throat, which promptly responds to saline gargles, or a feeling of distention from the insufflated air that was used during the procedure. Both problems are mild and transient. When fully recovered the patient will be instructed when to resume their usual diet (probably within a few hours) and the patient's driver will be allowed to take you home. (Because of the use of sedation, most facilities mandate that the patient be taken by a driver and not drive, handle machinery, or make important decisions for the remainder of the day.)

When do I get the results of the endoscopy?

Under most circumstances the examining physician will inform the patient of the test results or the probable findings prior to discharge from the recovery area. The results of biopsies or cytology usually take 72-96 hours and the doctor may only give the patient a presumptive diagnosis pending the definitive one, after the microscopic examination.

What are the risks of endoscopy?

Endoscopy is a safe procedure and when performed by a physician with specialized training in these procedures, the complications are extremely rare. They may include localized irritation of the vein where the medication was administered, reaction to the medication or sedatives used, complications from pre-existing heart, lung, or liver disease, bleeding may occur at the site of a biopsy or removal of a polyp (which if it occurs is almost always minor and rarely requires transfusions or surgery). Major complications such as perforation (punching a hole through the esophagus, stomach, or duodenum) are rare but usually require surgical repair.

What if there are still remaining questions about endoscopy?

If the patient still has any questions about their need for this exam, the cost of this procedure and whether it is covered by the patient's insurance, methods of billing, or any concerns about this exam, do not hesitate to speak to the doctor or his staff about them. Most endoscopists are highly trained specialists and will be happy to discuss with the patient their qualifications and answer any questions.

What is balloon endoscopy?

There are two types of balloon endoscopy: single balloon and double balloon.

Single balloon endoscopy

For single balloon endoscopy, a 200 cm long flexible, fiberoptic, endoscope (a hose-like tube one centimeter in diameter with a light and a camera on the tip) is fitted with an equally long overtube that slides the full length of the endoscope. On the tip of the overtube is a balloon that can be blown up and deflated. The balloon when blown up is used to anchor the overtube within the intestine. While the overtube is anchored, the endoscopy can be advance further into the small intestine. By withdrawing the overtube the small intestine can be shortened and straightened to make the passage of the inner endoscope easier. The balloon may then be deflated so that the overtube can be inserted further and the endoscope advanced again.The endoscope itself is a standard endoscope with working channels that allow the intestine to be inflated with air, rinsed with water, or to guide biopsy or electrocautery instruments to the tip of the endoscope.

Double balloon endoscopy

For double balloon endoscopy, similar equipment is used, but a second balloon is located on the tip of the endoscope. Both balloons - the one on the overtube and the one on the endoscope - can be alternatively inflated to anchor the overtube or the endoscope to assist with the passage of the endoscope or overtube, respectively.

What to expect with balloon endoscopy

Balloon endoscopy, like other gastrointestinal endoscopy, requires intravenous sedation. The procedures are long, often requiring 1-3 hours. The most important complications of balloon endoscopy are perforation of the small intestine or bleeding either due to insertion of the endoscope or use of therapeutic instruments.

What is the future for balloon endoscopy?

Balloon endoscopy is revolutionizing the diagnosis and treatment of small intestinal diseases. Nevertheless, its use is restricted because of the large expenditure of time that is necessary to perform it. Either newer, faster systems will need to be designed or, perhaps, paramedical personnel will be needed to perform the insertions before balloon endoscopy is as commonly performed as other types of endoscopy. For now, when there is concern about disease in the small intestine, wireless capsule endoscopy often is performed first. Then, if abnormalities are found, or if despite a normal capsule endoscopy there still is a strong suspicion that there is disease in the small intestine, balloon endoscopy is performed

What is capsule endoscopy?

Capsule endoscopy is a technology that uses a swallowed video capsule to take photographs of the inside of the esophagus, stomach, and small intestine. For capsule endoscopy, the intestines are first cleared of residual food and bacterial debris with the use of laxatives and/or purges very similar to the laxatives and purges used before colonoscopy. A large capsule-larger than the largest pill-is swallowed by the patient. The capsule contains one or two video chips (cameras), a light bulb, a battery, and a radio transmitter. As the capsule travels through the esophagus, stomach, and small intestine, it takes photographs rapidly. The photographs are transmitted by the radio transmitter to a small receiver that is wornon the waist ofthe patient who is undergoing the capsule endoscopy. At the end of the procedure, approximately 24 hours later, the photographs are downloaded from the receiver into a computer, and the images are reviewed by a physician. The capsule is passed by the patient into the toilet and flushed away.

What are the limitations of capsule endoscopy?

While the capsule provides the best means of viewing the inside of the small intestine, there are many inherent limitations and problems with its use, the most important of which is thatthe capsuledoes not allow for therapy. Other problems include:

1. Abnormalities in some areas of the intestine are missed because of rapid transit of the capsule and blurred, uninterpretable photographs.
   
   
2. At times, transit is so slow that the capsule examines only part of the small intestine before the battery fails.
   
   
3. If abnormalities are discovered that require surgical resection or further investigation, it may be difficult to determine where in the small intestine the abnormality is and thereby help direct therapy.
   
   
4. If there are narrow areas due to scarring (strictures) or tumors in the small intestine, the capsule can get stuck in the narrow area and cause an obstruction of the intestine that requires surgical removal of the capsule. (For this reason, in patients who are suspected of having a stricture, a self-dissolving, dummy capsule is swallowed first. If the dummy capsule sticks, it can be seen on an x-ray of the abdomen and the location of the stricture determined. Because it dissolves with time, however, the obstruction will resolve without surgery, and the real capsule will not be swallowed.)
   
   
5. Finally, reviewing the tens of thousands of photographs is very time consuming for the conscientious physician.

What type of diseases can be diagnosed with capsule endoscopy?

Capsule endoscopy continues to improve technically. It has revolutionized diagnosis by providing a sensitive (able to identify subtle abnormalities) and simple (non-invasive) means of examining the inside of the small intestine. Some common examples of small intestine diseases diagnosed by capsule endoscopy include:

1. Angiodysplasias (collections of small blood vessels located just beneath the inner intestinal lining that can bleed intermittently and cause anemia)
   
   
2. Small intestinal tumors such as lymphoma, carcinoid tumor, and small intestinal cancer
   
   
3. Crohn's disease of the small intestine
4. source:medicinenet.com