Upper GI Endoscopy

Your doctor may recommend upper GI endoscopy to diagnose and possibly treat a variety of diseases and conditions of the esophagus, stomach and duodenum, which is the first section of the small intestine. These include:

• Cancer, tumor or mass of the esophagus, stomach or duodenum

• Crohn’s disease, a form of inflammatory bowel disease

• Early fullness after eating small meals. Also called early satiety, feeling full fast after eating a small amount of food can be due to problems in the gastrointestinal tract.

• Esophageal varices, which are swollen veins in the esophagus that can bleed

• Foreign body evaluation and removal

• Gastrointestinal symptoms, such as abdominal pain, chronic vomiting, heartburn, regurgitation, and dysphagia (the sensation of food being stuck), or odynophagia (painful swallowing) if the underlying cause has not been found through other, less invasive tests

• Unexplained weight loss if the underlying cause has not been found through less invasive tests

• Upper gastrointestinal bleeding, which can show up as unexplained anemia, vomiting blood, or black or tarry stools

• Upper gastrointestinal diseases, such as peptic ulcer, Barrett’s esophagus, strictures, gastroesophageal reflux disease (GERD), acid reflux, hiatal hernia, or heartburn

The following specialists commonly perform upper GI endoscopy:

• Gastroenterologists are internists who specialize in diseases of the digestive system.

• Pediatric gastroenterologists specialize in diagnosing and treating digestive system and nutritional problems in children.

Other specialists who perform upper GI endoscopy:

• General surgeons and pediatric surgeons specialize in the surgical treatment of a wide variety of diseases, disorders and conditions.

An Upper GI endoscopy is performed in a hospital or outpatient surgical setting. It takes about 10 to 25 minutes and generally includes these steps:

1. You dress in a patient gown. Your care team positions you on an examination table. Your care team will give you blankets for modesty and warmth as needed.

2. Your doctor or care team will spray a topical anesthetic into the back of your throat to numb it and reduce the gag reflex. Your doctor may give you a light sedative to make you drowsy and relaxed, and possibly a pain medication. Medication may be given intravenously (through an IV). With IV sedation, called conscious sedation, you will be very relaxed and may be unaware of the procedure. You may not even remember it. Your care team monitors your vital signs during IV sedation.

3. Your doctor has you wear a special mouth guard to protect your teeth during the procedure.

4. Your doctor will insert a thin, flexible endoscope through your mouth or nose, through the throat, and into the esophagus, stomach and duodenum. The doctor takes pictures and the images are transmitted onto a video screen.

5. Your doctor will gently pull the endoscope out of the esophagus. This is when the most careful examination is carried out and procedures, such as tissue biopsy and treatments, are generally performed.

Will I feel pain?

Your comfort and relaxation is very important to both you and your care team. You may feel pressure in your throat and you will not be able to talk during the procedure. Your care team will give you pain and sedative medications to keep you calm and comfortable. In fact, patients often fall asleep during the procedure.

Complications of an upper GI endoscopy are not common. However, any procedure involves risks and the possibility of complications that may become serious in some cases. Complications can develop during the procedure or recovery. Risks and potential complications of upper GI endoscopy include:

• Adverse reaction or problems related to sedation or medications, such as an allergic reaction and problems with breathing

• Bleeding

• Difficulty swallowing and sore throat

• Esophageal or intestinal perforation or tear

• Infection

• Injury to your teeth, jaw joint, lips, or throat

• Pain

Reducing your risk of complications

You can reduce the risk of certain complications by:

• Following activity, dietary and lifestyle restrictions and recommendations before your procedure and during recovery

• Notifying your doctor immediately of any concerns, such as bleeding, fever, or increase in pain

• Taking your medications exactly as directed

• Telling all members of your care team if you have any allergies

If you dread the thought of undergoing upper GI endoscopy, you are not alone. You are an important member of your own healthcare team. The steps you take before your procedure can improve your comfort and outcome. You can prepare for upper GI endoscopy by:

• Answering all questions about your medical history and medications you take. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.

• Completely following all your doctor’s specific instructions. This generally includes not eating or drinking anything from six hours before the procedure.

• If you wear dentures, you will need to remove them for the procedure. It is a good idea to leave them with a family member or at home if possible.

• Taking or stopping medications exactly as directed. For upper GI endoscopy, this may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners. You doctor will give you instructions for taking your specific medications and supplements.

Questions to ask your doctor

Preparing for upper GI endoscopy can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointments. Contact your doctor with concerns and questions before the procedure and between appointments.

It is also a good idea to bring a list of questions to your appointment. Common questions include:

• Why do I need upper GI endoscopy? Are there any other options for diagnosing or treating my condition?

• How long will the procedure take? When can I go home?

• What kind of restrictions will I have after the procedure and when can I expect to return to work and other activities?

• What kind of assistance will I need at home? Will I need a ride home?

• What medication plan should I follow before and after the procedure?

• How will you manage my pain?

• When should I follow up with you?

• How should I contact you? Ask for numbers to call during and after regular hours.

• When will I receive the results of my test?

Knowing what to expect after upper GI endoscopy can help you get back to your everyday life as soon as possible.

How will I feel after upper GI endoscopy?

You may have a sore throat, bloating, gas and cramping after the procedure. These symptoms should be mild and pass over a brief time. Call your doctor if they are not improving rapidly or are getting worse, because this can be a sign of a complication. You might also feel a little drowsy for about 24 hours from the sedative.

When can I go home?

You will need to stay in the doctor’s office, surgical outpatient facility, or hospital for a short time after your upper GI endoscopy. The doctor will discharge you when you are alert, breathing effectively, and your vital signs are stable. This generally takes an hour or two, depending on the type of sedation you had and other factors.

You will not be able to drive for about 24 hours after sedation. You will need a ride home from your procedure. Someone should stay with you for a day or so because you may still be a bit drowsy.

When should I call my doctor?

It is important to keep your follow-up appointments after upper GI endoscopy. Call your doctor if you have questions or concerns between appointments. Call your doctor if you have:

• Bleeding including bloody or black stools, rectal bleeding, or vomiting blood

• Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing

• Cough that does not go away

• Difficulty swallowing

• Fever

• Pain or discomfort that gets worse or does not go away as expected

• Sore throat or hoarseness that lasts longer than expected