The term “endoscopy” refers to a special technique for looking inside a part of the body. “Upper GI” is the portion of the gastro-intestinal tract, the digestive system, that includes the esophagus( Food Pipe), the stomach, and the duodenum ( the beginning of the small intestine).
Upper GI endoscopy is a procedure performed by a gastroenterologist, a well-trained specialist who uses the endoscope to diagnose and, in some cases, treat problems of the upper digestive system.
The endoscope is a long, thin, flexible tube with a tiny video camera and light on the end.
The doctor may start by spraying your throat with a local anaesthetic. Then you will be given sedation to help you relax.
You will then lie on your left side, a mouth piece will be put in your mouth and the doctor will pass the tube into your mouth and down your food pipe (oesophagus), stomach and duodenum (small bowel leading from the stomach).
Small pieces of tissue (skin inside your oesophagus, stomach, duodenum) may need to be removed for pathology tests.
The endoscope does not cause problems with breathing unless you have lung or heart problems.
Before the Procedure
Regardless of why upper GI endoscopy has been recommended for you, there are important steps you can take to prepare for and participate in the procedure.
To properly prepare for your procedure, you may need to make certain changes to your daily medication routine.
- If you take insulin or diabetic tablets, consult with your physician about making any necessary changes in you daily regimen.
- You must tell your doctor what drugs you are taking, particularly: Aspirin products, Arthritis drugs, Blood thinners eg. Warfarin (anticoagulants). It may be necessary to stop taking them seven days before your procedure. They may increase your risk of bleeding after removal of a polyp or a biopsy during your upper GI endoscopy by interfering with the normal clotting of your blood. IF YOU ARE TAKING COUMADIN OR HEPARIN, YOU MUST CHECK WITH YOUR PRESCRIBING PHYSICIAN BEFORE CHANGING OR INTERRUPTING YOUR DAILY ROUTINE.
- Certain medications should be continued prior to your upper GI endoscopy. If you take cardiac (heart) or anti-hypertensive (high blood pressure) pills, take them as you normally do with small sips of water.
In addition to changes to your medication, you'll also need to:
- Bring a list of all your medications (prescription medications, over-the-counter medications and eye drops) with you on the day of your procedure. You may bring the medication bottles themselves.
- Be prepared to list and describe your ALLERGIES and REACTIONS to any medications.
Tell the doctor if you have: a pacemaker, a joint replacement, heart, lung or other medical conditions that may need special attention .
Tell your doctor if you have to take antibiotics before dental treatment. If so, you may also need antibiotics before an upper endoscopy
Because you will receive a relaxing medication during your procedure, you must arrange to have a responsible adult pick you up and/or accompany you home if you taking public transportation. You may not operate an automobile or other mechanical equipment until the day following your procedure.
Preparation for the Procedure
You must not eat or drink anything for at least six hours before the procedure. Ideally you must not eat or drink anything after midnight the night before your procedure. Food in the stomach will block the view through the endoscope and it could cause vomiting. The exception is medication taken with small sips of water.
If you are scheduled for a morning procedure: You should have nothing by mouth (including gum and mints) after midnight. The exception is medication taken with small sips of water.
If you are scheduled for an afternoon procedure: You may continue drinking small quantities of clear liquids up to 6 hours prior to your scheduled arrival time.
CLEAR LIQUIDS: water, apple juice, ginger ale, sprite, beef or chicken broth WITHOUT noodles, coffee or tea WITHOUT cream or milk, most sodas, sherbet, pop-sicles, and Jell-O that is not red or orange. DO NOT DRINK ANYTHING RED OR ORANGE.
- On the day of your upper GI endoscopy, please come directly to the requested location at your scheduled arrival time. Plan to spend several hours at the unit to allow time for your preparation, your procedure, and your recovery.
- Before the procedure, a nurse will greet you and assist you with changing into a hospital gown. An IV will be placed in your arm. You will receive relaxing medications through the IV during the procedure. You will be lying on your side during the upper endoscopy and the endoscope will be passed through your mouth and throat to view the upper digestive tract. The procedure takes approximately 15-30 minutes to complete.
During the Procedure
During the procedure, everything will be done to help you be as comfortable as possible. Your blood pressure, pulse and blood oxygen level will be carefully monitored. Your gastroenterologist may give you a sedative to help make you relaxed and drowsy, but you will remain awake enough to cooperate.
You may also have your throat sprayed or be asked to gargle with a local anesthetic to help keep you comfortable as the endoscope is passed through. A supportive mouthpiece will be placed to help you keep your mouth open during the endoscopy. Once you are fully prepared, your gastroenterologist will gently maneuver the endoscope into position.
As the endoscope is slowly and carefully inserted, air is introduced through it to help your gastroenterologist see better. During the procedure, you should feel little to no pain and it will not interfere with your breathing.
Your gastroenterologist will use the endoscope to look closely for any problems that may require evaluation, diagnosis or treatment.
In some cases, it may be necessary to take a sample of tissue, called a biopsy, for later examination under the microscope. This, too, is a painless procedure. In other cases, the endoscope can be used to treat a problem such as active bleeding from an ulcer.
Risks of this Procedure
There are some risks/ complications which include:
- A tear through the wall of the food pipe, stomach or duodenum (perforation). This is rare and may need surgery. There is also a risk of infection. This may result in a longer stay in hospital.
- Bleeding at a biopsy site or at the site where a polyp has been removed. This is usually minor and can usually be stopped through the endoscope. Rarely, surgery is needed to stop bleeding.
- Lung infection is uncommon and is due to vomit going into the lungs.
- Your procedure may not be able to be finished due to problems inside your body or because of technical problems.
- There is a rare possibility that defects or disease may be missed.
- Other potential risks include a reaction to the sedation used and complications from heart or lung diseases.
- Death is possible due to complications of the procedure, but is extremely rare.
After the Procedure
When your endoscopy is completed you will be cared for in a recovery area until most of the effects of the medication have worn off.
Occasionally, minor problems may persist, such as mild sore throat, bloating or cramping; these should disappear in 24 hours or less.The air put into your stomach during the test causes this.
You can usually eat and drink normally afterwards unless you are told otherwise.
By the time you are ready to go home, you’ll feel more alert. Nevertheless, you should plan on resting for the remainder of the day.
For your safety you must:
- Be taken home by a responsible person
- Have a responsible adult care for you that day/night or be on hand in case of any problems
- Not drive a car or motorcycle (this is against the law) or operate machinery until the following day or for as long as your doctor or anaesthetist advises
- Not make any important decisions or sign any contracts within 24 hours of the procedure (the medication used may impair judgement)
- Not drink any alcohol for 24 hours post procedure
Tell your doctor immediately if you:
- Feel generally ill with or without headache, chills or muscle aches
- Have a high temperature/fever
- Have trouble swallowing
- Are dizzy, short of breath or feel faint
- Start to get sharp pains in the throat, chest or stomach or begin vomiting
Your doctor will explain the results of the examination to you or arrange for you to come back to hospital and talk to you about the results.