Upper Endoscopy

WHAT IS UPPER ENDOSCOPY
WHERE AND HOW IS IT DONE?
RISKS
SIDE EFFECTS
ALTERNATIVES
PRE PROCEDURE
POST PROCEDURE
 

WHAT IS THE FUNCTION OF THE UPPER ENDOSCOPY TRACT?

The upper gastrointestinal tract is divided into three sections - the esophagus, stomach and duodenum (the first part of the small intestine). The esophagus is a tubular organ that delivers food from the mouth to the stomach. The stomach is an organ that is bathed in acid produced by certain cells in the upper portion of the organ. Food is mixed with acid in the stomach, churned, and slowly released into the duodenum where digestion and absorption begins.

What is upper endoscopy?

 

 

Upper endoscopy is the examination of the upper gastrointestinal tract through the use of a long, flexible scope. The procedure allows your physician to observe all parts of the upper gastrointestinal tract with little or no discomfort to the patient. The instrument used is an upper endoscope. It is a long, thin, flexible tube about twice the diameter of a pencil. There are approximately four channels within the "scope" through which the physician may illuminate, wash, suction, photograph and biopsy the upper gastrointestinal tract. These channels provide the means for biopsying abnormal tissue, removing polyps, cauterizing blood vessels to stop active bleeding, or to prevent re-bleeding. In addition, sclerosing agents can be injected into varices, (dilated vessels seen in the upper portion of the stomach or esophagus in patients with cirrhosis of the liver), or these varices can be banded with small rubber bands. Strictures (narrowed areas in the upper GI tract secondary to scarring from reflux or ulcer disease), can be dilated utilizing several different types of dilators.

Where and how is it done?

Arrangements for your procedure will be made by this office but the procedure will be preformed at the endoscopy center. Special written instructions preparing you for your procedure will be given to you.  These are important to obtain a good quality exam and should be followed carefully, to minimize the risk of aspirating stoomach contents into the lungs.  Upon admission you will be asked a series of medically related questions. You will change into a hospital gown and be shown to a bed. Any family member or a friend may accompany you and will be asked to stay in the waiting room. Due to the amnesia-like effects of the sedation used for upper endoscopy, it is likely you will not remember information given to you immediately following your procedure. Therefore, your doctor will have the discharge nurse/clinician speak with you and your family approximately 30 minutes after the completion of your procedure. At that time the procedure findings will be explained to you. You will be scheduled for any follow-up procedures that might be necessary, and any questions you and your family might have will be answered.

In our experiences, the majority of patients want to go home as soon as possible after their procedure. However, if you wish to speak to your physician, he/she will be happy to accommodate your request.

Due to the nature of the medications used during the procedure, it is absolutely mandatory that you have someone available after the procedure to drive you home. Once you have returned home, do not operate dangerous machinery, and be sure not to drive for at least 24 hours, since minor effects of the drugs may persist the rest of that day.

Pathology results from tissue removed/biopsied is routinely available within 14 days. If you have not received notification after this period of time please call our office.

What are the risks involved in upper endoscopy?

It is your right to be thoroughly informed of the risks and possible complications before you decide whether or not to undergo the recommended upper endoscopy procedure.

  • There is a 1 in 100 chance of some complications when upper endoscopy is used to diagnose your problem, but most of these are very minor, and serious problems are uncommon.
  • There is a risk of bleeding in about 1 of 3000 procedures. Any persistent bleeding that is manifested by vomiting blood or passing black bowel movements should be reported to your physician.
  • There is a risk of perforating the upper gastrointestinal tract with the scope in about 1 of 4000 procedures.
  • There is a risk of temporary irregularity of the heart. For this reason, if you have a history of heart disease your heart may be monitored with an electrocardiogram to minimize risk to you.
  • There is a risk of an allergic or other reaction to the drugs administered during the procedure. These are rare and the effects of the drugs can be reversed with other drugs.
  • There is a risk of aspiration (vomiting stomach contents and going into the lungs). This is rare and the stomach should be empty at the time of the procedure.
  • There is a slightly higher risk of complications if dilation or sclerotherapy is performed during your procedure.
  • Death is extremely rare but remains a possibility.

 

Once the inspection is complete the upper endoscope will be removed. The entire examination requires between 10 and 30 minutes. You will then be taken to the postoperative area for recovery. It is very common, due to the nature of the medications used for sedation, for patients to remember little or nothing of the procedure. You may experience some abdominal discomfort due to the presence of gas which may last for 20-to-30 minutes, but generally this is minimal.

Although any medical test has some risk associated with it, in actuality, serious problems with upper endoscopy are very uncommon, and when they occur are very treatable. Because of its acceptability, low risk, accuracy, and the wide variety of tasks it can accomplish, upper endoscopy is well recognized as a very important test in appropriate situations, and is used frequently in patients with upper gastrointestinal symptoms or problems.

What are the side effects?

Abdominal gas or bloating caused by the introduction of air into the stomach may cause some discomfort for a short time after the procedure. Belching or passing gas will help to relieve this symptom. Refrain from eating large amounts of food until you have returned to your normal state of comfort.

Uncommonly, nausea my result from the abdominal gas and/or the medications used during the procedure. It is recommended that you remain on clear fluids until the nausea subsides. Should vomiting occur for an extended period of time (more than 6 hours), please notify your physician. Bedrest is recommended.

Occasionally a sore throat may be present following the procedure due to the passage of the scope through the oropharynx into the esophagus. If this occurs, it is generally mild and lasts only for 1-to-2 days. Topical therapy with throat lozenges or sprays usually help to relieve this symptom, and gargling with saltwater may help to decrease inflammation. If a severe sore throat is present or this symptom persists longer than 3 days, you should call your physician.

Localized irritation of the vein (phlebitis) is rare but may occur at the site of medication injection. A tender lump develops which may remain for several weeks to several months, but goes away eventually. Elevation of the arm and warm set compresses applied to the site several times per day should rectify the situation. If a red streak should form which appears to follow the route of a vein and extends up your arm, please notify your doctor at once. If any serious or persistent symptoms develop you should notify your doctor.

What are the alternatives?

The most common alternative to upper endoscopy is an upper GI x-ray examination utilizing barium. This examination requires that you swallow barium (a chalky liquid), and x-rays are taken. Some abnormalities of the upper gastrointestinal tract can be detected by studying these films; however, the procedure is generally recognized as not being as accurate as an upper endoscopy, and does not allow for biopsy and removal of tissue.

Other procedures which may be done prior to upper endoscopy (but are not considered alternatives to the procedure), are CAT scan, ultrasound, and nuclear medicine scans. These studies are utilized to assess other structures, but may complement the findings of endoscopy.

Pre Procedure

When your procedure is scheduled, you will be given specific instruction for preparing for your exam.  The prep instructions vary, depending on the time of your appointment as well as other factors.  If you have any questions regarding your prep, contact our office at 541 868-9500.  Urgent concerns outside of the office hours should be directed to the on-call physician at 541 868-9500 (toll free 877 484-4501).

 

Post Procedure

Sore Throat

You may experience a sore throat following the procedure which may last for several hours.  Once your swallowing reflex has returned, you will find warm drinks very soothing.  You may also take Tylenol for the minor discomfort, but be sure to inform your physician if the symptoms worsen.

Gas

You may experience some gas pain since the stomach is inflated with air during the examination.  This discomfort should pass with burping and the passage of several hours.  However, if the pain continues or you feel any other discomfort, you should tell your nurse or physician immediately.

Nausea

Nausea may be caused by the presence of gas, effects of medication used, or pain.  This condition may last several hours; however, should it persist into the next day, your doctor should be notified. Drink only clear liquids (fluids which you can see through), and do not eat any solid food until the nausea subsides.  If vomiting should occur, notify your doctor.

I.V. Site

Localized irritation of the vein (phlebitis) may occur at the site of medication injection and is not unusual.   There may be a red streak going up your arm that is best treated with moist hot packs. If it progresses, call Eugene Gastroenterology as antibiotic therapy may be required to resolve this condition.

FEVER, SEVERE PAIN OR EXCESSIVE BLEEDING SHOULD BE REPORTED TO YOUR DOCTOR IMMEDIATELY.

Forgetfulness is normal immediately after the procedure and is due to the use of a sedative during the endoscopy.  Should you have any questions after your procedure, please call 868-9500 (or toll free 1-877-484-4501) and ask for your physicians’ triage nurse

If any tissue was removed, analysis of the biopsied tissue will be performed.  Results will be sent to you within 14 days.  If you have not heard from us within this time frame please call and ask for your physician’s triage nurse.

 

Note: The information in this section is provided as a supplement to information discussed with your healthcare provider. It is not intended to serve as a complete description of a particular topic or substitute for a clinic visit.

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