Test Overview
An upper gastrointestinal (UGI) endoscopy is
a procedure that allows your doctor to look at the inside lining of your
esophagus, your stomach, and the first part of your
small intestine (duodenum). A thin, flexible
viewing tool called an endoscope (scope) is used. The tip of the scope is inserted
through your mouth and then gently moved down your throat into the esophagus,
stomach, and duodenum (upper gastrointestinal tract).
This
procedure is sometimes called esophagogastroduodenoscopy (EGD).
Using the scope, your doctor can look for
ulcers, inflammation, tumors, infection, or bleeding.
He or she can collect tissue samples (biopsy), remove
polyps, and treat bleeding through the scope. Your doctor may find problems that do not show up on
X-ray tests.
This test can sometimes prevent the need for exploratory
surgery.
Why It Is Done
An upper gastrointestinal (UGI) endoscopy may be done to:
- Find problems in the upper gastrointestinal
(GI) tract. These problems can include:
- Find the cause of vomiting blood.
- Find the cause of symptoms, such as upper belly
pain or bloating, trouble swallowing (dysphagia), vomiting, or
unexplained weight loss.
- Find the cause of an
infection.
- Check the healing of stomach ulcers.
- Look
at the inside of the stomach and upper small intestine (duodenum) after
surgery.
- Look for a blockage in the opening between the stomach and
duodenum.
Endoscopy may also be done to:
- Check for an injury to the esophagus in an emergency.
(For example, this may be done if the person has swallowed poison.)
- Collect tissue
samples (biopsy) to be looked at in the lab.
- Remove growths (polyps)
from inside the esophagus, stomach, or small intestine.
- Treat upper GI bleeding that may be causing anemia.
- Remove foreign objects that have been
swallowed.
- Treat a narrow area of the esophagus.
- Treat Barrett's esophagus.
How To Prepare
Before having an upper
gastrointestinal endoscopy, tell your doctor if you:
- Are allergic to any medicines, including
anesthetics.
- Are taking any medicines.
- Take a blood thinner or have had bleeding problems.
- Have heart problems.
- Are or might be
pregnant.
- Have
diabetes and take insulin.
- Have had
surgery or radiation treatments to your esophagus, your stomach, or the upper part
of your small intestine.
Do
not eat or drink anything for 6 to 8 hours before the test. An empty stomach
helps your doctor see your stomach clearly during the test. It also reduces
your chances of vomiting. If you vomit, there is a small risk that the vomit could enter your lungs. (This is called aspiration.) If the test is done in an
emergency, a tube may be inserted through your nose or mouth to empty your
stomach.
You may be asked to sign a consent form that says you understand the risks of the test and agree to have it done.
Talk to your doctor about any concerns you have about the need for
the test, its risks, how it will be done, or what the results will mean. To
help you understand the importance of this test, fill out the
medical test information form(What is a PDF document?).
You may be asked to stop taking
aspirin products, nonsteroidal anti-inflammatory drugs (NSAIDs), and iron supplements 7 to 14 days before the test. If you take
blood-thinning medicines regularly, talk with your doctor about how to manage your
medicine.
Do not take sucralfate (Carafate) or antacids on the day of
the test. These medicines can make it hard for your doctor to see your upper GI tract.
Before the test, you will put on a hospital gown. If you
are wearing dentures, jewelry, contact lenses, or glasses, remove them. For
your own comfort, empty your bladder before the test.
Arrange to have someone take you home after the test. You will be
given a sedative before the test and will need a ride home.
How It Is Done
A gastrointestinal endoscopy may be
done in a doctor's office, a clinic, or a hospital. An overnight stay in the
hospital usually isn't needed. The test is most often done by a doctor
who specializes in problems of the digestive system (gastroenterologist). The doctor may also have an
assistant. Some
family medicine doctors,
internists, and
surgeons are also trained to do this test.
Before the procedure, blood tests may be done to check for a low blood
count or clotting problems. Your throat may be numbed with an anesthetic spray,
gargle, or lozenge. This is to relax your gag reflex and make it easier to insert the
endoscope into your throat.
During the
test, you may get a pain medicine and a
sedative through an intravenous (IV) line in your arm
or hand. These medicines reduce pain and will make you feel relaxed and
drowsy during the test. You may not remember much about the actual test.
You will be asked to lie on your left side with your head bent
slightly forward. A mouth guard may be placed in your mouth to protect your
teeth from the endoscope (scope). Then the lubricated tip of the scope will be
guided into your mouth. Your doctor may gently press your tongue out of the
way. You may be asked to swallow to help move the tube along. The scope is no thicker than many foods you swallow. It will
not cause problems with breathing.
After the scope is in your
esophagus, your head will be tilted upright. This makes it easier for the scope
to slide down your esophagus. During the procedure, try not to swallow unless
you are asked to. Someone may remove the saliva from your mouth with a suction
device. Or you can allow the saliva to drain from the side of your mouth.
Your doctor will look through an eyepiece or watch a screen while he or she slowly moves the endoscope. The doctor will check the walls of your
esophagus, stomach, and duodenum. Air or water may be injected through the
scope to help clear a path for the scope or to clear its lens. Suction may
be applied to remove air or secretions.
A camera attached to the scope takes pictures. The doctor may also insert tiny tools such as forceps, clips, and
swabs through the scope to collect tissue samples (biopsy), remove
growths, or stop bleeding.
To make it easier
for your doctor to see different parts of your upper gastrointestinal (GI)
tract, someone may change your position or apply gentle pressure to your belly.
After the exam is done, the scope is slowly withdrawn.
After the test
The test usually takes 30 to 45
minutes. But it may take longer, depending upon what is found and what is done
during the test.
After the test, you will be observed for 1 to 2
hours until the medicines wear off. If your throat was numbed before the
test, you should not eat or drink until your throat is no longer numb and your
gag reflex has returned to normal.
When you are fully recovered,
you can go home. You will not be able to drive or operate machinery for 12
hours after the test. Your doctor will tell you when you can go back to your usual
diet and activities. Do not drink alcohol for 12 to 24 hours after the test.
How It Feels
You may notice a brief, sharp pain when
the intravenous (IV) needle is placed in a vein in your arm. The
local anesthetic sprayed into your throat usually
tastes slightly bitter. It will make your tongue and throat feel numb and
swollen. Some people report that they feel as if they can't breathe at times
because of the tube in their throat. But this is a false sensation caused by
the anesthetic. There is always plenty of breathing space around the tube in
your mouth and throat. Remember to relax and take slow, deep breaths.
During the test, you may feel very drowsy and relaxed from the sedative
and pain medicines. You may have some gagging, nausea, bloating, or mild
cramping in your belly as the tube is moved. If you have pain, alert your
doctor with an agreed-upon signal or a tap on the arm. Even though you won't be
able to talk during the procedure, you can still communicate.
The
suction machine used to remove secretions may be noisy, but it does not cause pain. The removal of biopsy samples is also painless.
You will feel
groggy after the test until the medicine wears off. This usually takes a few hours.
Many people report that they remember very little of the test because of the
sedative given before and during the test.
After the test, you may
belch and feel bloated for a while. You may have a tickling, dry throat or mouth. You may feel a bit hoarse, and you may have a mild sore throat. These symptoms may last several days.
Throat lozenges and warm saltwater gargles can help relieve the throat
symptoms.
If your child is having this procedure, the same is also true. If your child has a sore throat and is age 4 or older, you can give him or her throat lozenges. Also, a child age 8 or older can gargle with warm salt water.
Do not drink alcohol after the test.
Risks
Complications are rare. There is a slight risk that your esophagus,
stomach, or upper small intestine will get a small hole in it. If this happens, you may need to
have surgery to fix it. There is also a slight chance of infection after an
endoscopy.
Bleeding may also occur from the test or if a tissue
sample (biopsy) is taken. But the bleeding usually stops on its own without treatment.
If you vomit during the exam and some of the vomit enters
your lungs,
aspiration pneumonia is a possible risk. If it
happens, it can be treated with antibiotics.
An irregular
heartbeat may occur during the test. But it almost always goes away on its own
without treatment.
The risk of problems is higher in people who have serious heart disease, older adults, and those who are frail or physically
weakened. Talk to your doctor about your specific
risks.
After the test
After the test, call 911 or other emergency services right away if you have:
After the test, call your doctor right away if
you:
- Feel short of breath or
dizzy.
- Have symptoms of infection, such as fever or chills.
- Vomit blood, whether it is fresh and red or is old and looks
like coffee grounds.
Results
An upper gastrointestinal (UGI)
endoscopy allows your doctor to look at the inside lining
of your esophagus, your stomach, and the first part of your small intestine
(duodenum). The doctor uses a thin, flexible viewing tool called an endoscope.
Your doctor may be able to talk to you about
some of the findings right after your endoscopy. But the medicines you get to help relax you may impair your
memory, so your doctor may wait until they fully wear off. It may take 2 to 4 days for some results. Tests for certain infections may
take several weeks.
Upper gastrointestinal endoscopy findings| Normal: | The esophagus, stomach, and upper small
intestine (duodenum) look normal. |
|---|
| Abnormal: | Inflammation or irritation is found in the esophagus, stomach, or small intestine. |
|---|
Bleeding, an ulcer, a tumor, a tear, or
dilated veins are found. |
A
hiatal hernia is found. |
A too-narrow section (stricture) is found in the esophagus. |
A foreign object is found in
the esophagus, stomach, or small intestine. |
A biopsy sample may be taken to:
- Find out if tumors or ulcers contain cancer
cells.
- Identify a type of bacteria called
H. pylori or a fungus such as candida that sometimes causes infectious esophagitis.
Many conditions can affect the results of this test. Your doctor will discuss your results with you in relation to your symptoms and past health.
What Affects the Test
You may not be able to
have the test, or the results may not be helpful, if you just had another test that uses barium
contrast material. An upper gastrointestinal endoscopy
should not be done less than 2 days after you have a type of X-ray test called an upper gastrointestinal
(GI) series so your doctor can see your stomach and small
intestine.
What To Think About
- An upper gastrointestinal (GI)endoscopy is the best
way to examine your esophagus, stomach, and upper small intestine (duodenum).
Your doctor can take a tissue sample to test for H. pylori infection, which is believed to be the main cause of stomach or
duodenal ulcers. To learn more, see the topic Helicobacter Pylori Tests.
- Cancer can be found or ruled out using endoscopy.
- Endoscopy may be done after an upper GI series test
finds a problem. To learn more, see the topic Upper Gastrointestinal Series.
- Small children can safely have endoscopy.
References
Other Works Consulted
- Chernecky CC, Berger BJ (2008). Laboratory Tests and Diagnostic Procedures, 5th ed. St. Louis: Saunders.
- Fischbach FT, Dunning MB III, eds. (2009). Manual of Laboratory and Diagnostic Tests, 8th ed. Philadelphia: Lippincott Williams and Wilkins.
- Pagana KD, Pagana TJ (2010). Mosby's Manual of Diagnostic and Laboratory Tests, 4th ed. St. Louis: Mosby Elsevier.
Credits
ByHealthwise Staff
Primary Medical ReviewerE. Gregory Thompson, MD - Internal Medicine
Adam Husney, MD - Family Medicine
Specialist Medical ReviewerJerome B. Simon, MD, FRCPC, FACP - Gastroenterology