Upper Endoscopy (EGD)
By gi health
All About Gastroscopy
After a careful medical assessment, your doctor has recommended that you should have a
gastroscopy examination, a non-surgical technique that can aid in diagnosing problems of
the upper digestive system. Based on the results of this exam, your doctor can then suggest
the best course of treatment for your problem. More accurate than a barium x-ray and
much simpler than exploratory surgery, gastroscopy is a safe and highly effective diagnostic
technique.
Understandably, most patients are a bit apprehensive about the idea of "swallowing a
scope." However, with the help of modern medical instruments and sedation, patients
usually tolerate this test with ease. After the test is completed, most patients are pleasantly
surprised by how easy it was. We have written this information to answer any questions
that you may have about gastroscopy. If you have additional questions or concerns after
reading it, please feel free to consult your doctor.
REASONS FOR THE EXAM
Disorders of the upper digestive tract are quite common in our stressful society. Various
factors such as diet, environment, and heredity contribute to these conditions. Gastroscopy
is often useful in diagnosing and treating problems such as:
Abdominal pain
Bleeding from the digestive tract
Cancers of the stomach or esophagus
Chronic heartburn and indigestion
Diagnosis and removal of stomach polyps
Dilatation of esophageal strictures
Gastritis, or stomach inflammation
Hiatal hernia
Removal of swallowed objects
Trouble swallowing
Treatment of the "Ulcer Bacteria"
Ulcers of the esophagus
Ulcers of the stomach and ulcers of the duodenum
Unexplained chest pain
THE SCOPE
Gastroscopy is a medical term that has two parts: gastro for "stomach," and scopy for
"looking." Gastroscopy, then, is a diagnostic test that enables the doctor to look inside your
stomach. The instrument used to perform this simple test is the gastroscope; a long, thin,
flexible fiberoptic tube. Within the end of this remarkable device is a miniaturized color TV
camera with a wide angle lens. By passing this "scope" into your stomach, your doctor can
directly examine the lining of your upper digestive system on a television monitor. The
technical name for this test is Esophago-Gastro-Duodenoscopy. To simplify things the
shortened form of the name GASTROSCOPY is usually used, or the initials EGD. The
examination is quick and painless. There is no incision.
ALTERNATE TESTING
As part of your evaluation, your family doctor may have already ordered a barium x-ray of
your upper digestive system - an UPPER GI SERIES. This x-ray exam may have been helpful
in directing attention to an area of possible abnormality. But x-rays often do not fully reveal
what is wrong. In fact, it is believed that the standard Upper GI x-ray may miss up to 30%
of peptic ulcers.
Fortunately, gastroscopy permits a much more
system. Rather than studying an indirect x-ray
gastroscopy allows your doctor to directly view
and to examine the lining in remarkable detail.
accurate view of your upper digestive
"shadow picture" of your stomach,
your upper digestive tract in "living color"
Thus, it is much more accurate.
HOW CAN YOU HELP?
Your cooperation is essential for a successful examination. There are certain things that you
can do before the test to help:
Preparation
Your stomach must be empty during gastroscopy so that your doctor's view is not blocked
by particles of food. If your test is scheduled in the morning, you must not eat or drink
anything after midnight the night before the test. You may gargle and brush your teeth in
the morning.
If your test is scheduled in the afternoon, you may have only liquids - such as juice, coffee,
tea, broth - for breakfast. Then begin fasting. You should not eat or drink anything for at
least 6 hours before the exam.
Medications
You may continue to take any important medications that your personal physician has
prescribed - even on the morning of the test. Simply take them with a small sip of water at
least two hours before your appointment. This allows time for the tablets to dissolve
completely. You should not take any antacids on the day of the test. If you are a diabetic on
insulin, call for special instructions. Do not use tobacco within two hours of your test since
this tends to affect the natural color of your stomach lining.
What To Wear
You will have to change into a patient gown before the examination. If this test is being
done on an outpatient basis, you should wear loose, comfortable, casual clothing that is
easily removed and folded. Avoid girdles, pantyhose, or tight-fitting garments. Please leave
your jewlery, valuables, and high heels at home.
Transportation
To minimize any discomfort, you will receive a sedative injection before the examination. As
this medication will make you drowsy for several hours, you cannot safely drive a car for the
remainder of the day. Therefore, if this test is being done on an outpatient basis, a family
member or friend must accompany you to the office in order to drive you home. If possible,
you should choose someone with whom the doctor can freely discuss the results of your
test. We request that your companion remain in the office during the test. You should plan
to arrive fifteen minutes before your appointment and to stay approximately two hours.
Of course, if this test is being done on a hospital inpatient basis, a driver will not be needed.
After the examination, you will simply return to your hospital bed to sleep off the remainder
of the medication.
Your Permission
If you have any questions about this test, do not hesitate to ask the GI Assistant, nurse, or
doctor. To signify that you completely understand what this test involves, you will be asked
to sign a written consent form, or "permit," before the test begins.
LOOKING INSIDE...
Before the test begins, you will be asked to remove any dentures or eyeglasses. Contact
lenses need not be removed.
To make this examination more comfortable, the GI Assistant will then spray the back of
your throat with a liquid anesthetic. This may taste slightly bitter and will produce a
numbness in your mouth and throat. This effect will last approximately one half hour. Then
you will be positioned comfortably on your left side on the padded examination table. A
small painless oximeter probe will be placed on your fingertip to monitor your pulse rate and
breathing function during the exam.
To maximize your comfort during the examination, you will then be given an intravenous
injection of Demerol, a pain killer, combined with Versed, a mild tranquilizer. If you are
allergic to either of these medications, please inform your doctor. These medications will
make you drowsy and relaxed. You will not be deep asleep like a general anesthetic, but
your doctor will give you sufficient medication to induce a pleasant "twilight sleep." In this
manner, you should feel no discomfort during the test. Upon awakening, you will probably
have little recollection of the procedure, itself. Once you are very relaxed, the doctor will
gently insert the flexible gastroscope. Since this scope does not enter your "windpipe," it
will not interfere with your ability to breathe. The most frequent fear expressed by patients
is that they will be unable to swallow the scope because of gagging. Fortunately, the
medications given prior to the procedure usually prevent this from happening. Even the
most apprehensive patients tolerate the procedure quite well.
A small mouthpiece will then be placed between your teeth enabling you to relax your jaws.
To better see the lining of your upper digestive tract, your stomach is then gently filled with
a small quantity of air. While this air may cause the sensation of abdominal fullness, it
should not be painful. Your doctor can now begin to inspect the lining of your esophagus,
stomach, and duodenum, an exam that takes about fifteen minutes.
TAKING SPECIMENS
If your gastroscopy reveals any abnormal condition such as an ulcer, your doctor may
photograph it. This picture provides a permanent record for your medical chart and also
enables your other doctors to see what is wrong. If necessary, a videotape of the procedure
may be recorded for later review.
To better evaluate areas of abnormality, your doctor may take a biopsy. This procedure is
performed painlessly with a miniature forceps. After passing the forceps through a hollow
channel inside the gastroscope, your doctor simply snips off a tiny sample of tissue for
laboratory analysis. If a small growth called a polyp is found, it can often be removed for
analysis. This is done by using a thin wire-loop snare which cuts off the polyp and then
cauterizes the base using electric heat. This is also painless.
Be assured that your doctor's decision to take a biopsy does not necessarily mean that
cancer is suspected. Biopsies of the digestive tract are routinely taken to investigate other
problems such as inflammation and ulcers.
If you have difficulty swallowing and the doctor finds a narrowed area in your esophagus, it
may be possible to dilate this "stricture" during this exam with a small balloon dilator.
AFTER THE TEST
After an outpatient gastroscopy, you will rest awhile in the office recovery room. Your
companion will be asked to sit with you while the effects of the sedation wear off. Initially
you may feel slightly bloated from the air that was placed in your stomach during the
examination. This feeling will gradually subside. Once you are more alert, the doctor will
meet with you to discuss the test's findings as well as any recommended treatment. If a
biopsy was obtained, the doctor will contact you with the results when they become
available.
You will then be able to return home with your companion's assistance. Since you will still
be somewhat drowsy and uncoordinated, you will be taken in a wheelchair to your car by
the office personnel.
Since the effects of the sedatives may take up to 24 hours to wear off completely, you
should plan to go directly home - not to a restaurant. Have a light meal, and rest for several
hours. After the sedation has completely worn off, you may resume your normal diet.
However, you will not be able to go to work, drive your car, or operate any dangerous
machinery for the remainder of the day. You may experience a mild sore throat after
gastroscopy. If this occurs, anesthetic throat lozenges, such as Cepacol or Sucrets, are
helpful.
IS THIS TEST DANGEROUS ?
While every medical procedure involves some degree of risk, the frequency of complications
during gastroscopy is extremely low. With the modern flexible fiberoptic instruments now
available, gastroscopy has become a safe and simple method of examining the upper
digestive tract. When performed by a physician who is specially trained and experienced in
this procedure, the benefits of gastroscopy far exceed its risks.
Your doctor is a GASTROENTEROLOGIST. In addition to standard medical training, he has
received special instruction in diseases of the digestive system and has been thoroughly
trained in the safe and proper operation of the gastroscope. The combination of this
experience and your cooperation should make this test as safe and simple as possible.
However, as with all medical procedures, complications can sometimes occur.
The main risks are perforation, or a tear, of the stomach or esophagus lining and bleeding.
Although perforation generally requires surgery, certain cases may be treated with
antibiotics and intravenous fluids. Bleeding may occur at the site of a biopsy or polyp
removal. Typically minor in degree, such bleeding may simply stop on its own or be
controlled by cauterization. Seldom does surgery become necessary. Fortunately, both
perforation and bleeding are extremely rare during gastroscopy. Other minor risks include
drug reactions and complications related to other diseases you may have. Consequently,
you should inform your doctor of all allergic tendencies and medical problems. Occasionally,
the site of the sedative injection may become inflamed and tender for a short time. This is
usually not serious and warm compresses for a few days are usually helpful. While any of
these complications may possibly occur, it is well to remember that each of them occurs
quite infrequently. Your doctor can further discuss the above risks with you with regard to
your particular need for gastroscopy.
HOW ABOUT AIDS ?
Due to the recent extensive coverage of AIDS in the media, some individuals have been
concerned that they might contract AIDS through this examination. Be assured that this is
not the case. All our instruments are extensively cleaned and undergo high level disinfection
between each case. Only techniques known to kill all disease-causing bacteria and viruses
including the AIDS virus are employed in this process.
A VALUABLE TOOL...
In summary, gastroscopy is a valuable tool for the diagnosis and treatment of diseases of
the upper digestive tract. Abnormalities suspected by X-ray can be confirmed and studied in
detail during this procedure. Even when X-rays are normal, the cause of such symptoms as
abdominal pain and internal bleeding can often be determined by gastroscopy. This
technique is useful in the diagnosis and follow-up of patients with peptic ulcers and also
allows dilatation of esophageal strictures. Gastroscopy is an extremely safe and worthwhile
procedure that is very well tolerated. If you have any questions or concerns regarding this
procedure, do not hesitate to consult your doctor.