Endoscopy

Definition

Endoscopy is a procedure used to visually examine your upper digestive system with a tiny camera on the end of a long, flexible tube. A doctor who specializes in diseases of the digestive system (gastroenterologist) uses endoscopy to diagnose and, sometimes, treat conditions that affect the esophagus, stomach and beginning of the small intestine (duodenum).

An endoscopy procedure involves inserting a long, flexible tube (endoscope) down your throat and into your esophagus. A tiny camera on the end of the endoscope lets your doctor examine your esophagus, stomach and the beginning of your small intestine (duodenum).

Doctors often refer to endoscopy as esophagogastroduodenoscopy (EGD) or upper endoscopy. Endoscopy may be done in your doctor's office, an outpatient surgery center or a hospital.

Why it's done

Endoscopy is used to diagnose and, sometimes, treat conditions that affect the upper part of the digestive system, including the esophagus, stomach and beginning of the small intestine (duodenum).

Your doctor may recommend an endoscopy procedure to:

• Investigate causes of digestive signs and symptoms. Endoscopy may help your doctor determine what's causing signs and symptoms, such as nausea, vomiting, abdominal pain, difficulty swallowing and gastrointestinal bleeding.
• Diagnose digestive diseases and conditions. Your doctor may use endoscopy to collect tissue (biopsy) samples to test for diseases and conditions, such as anemia, bleeding, inflammation, diarrhea or cancers of the digestive system.
• Treat certain digestive system problems. Using special tools during endoscopy allows your doctor to treat certain problems in your digestive system, such as bleeding from the esophagus or stomach and difficulty swallowing caused by a narrow esophagus, or to remove polyps. Endoscopy can also be used to remove foreign objects lodged in your upper digestive tract.

Your digestive tract stretches from your mouth to your anus. It includes the organs necessary to digest food and process waste.

Endoscopy is sometimes combined with other procedures, such as ultrasound. An ultrasound probe may be attached to the endoscope to create specialized images of the wall of your esophagus or stomach. An endoscopic ultrasound may also help your doctor create images of hard-to-reach organs, such as your pancreas.

Risks

Endoscopy is a safe procedure. However it carries a very small risk of complications, including:

• Bleeding. Your risk of bleeding complications after endoscopy is increased if the procedure involves removing a piece of tissue for testing (biopsy) or for treating a digestive system problem. In rare cases, such bleeding may require a blood transfusion.
• Infection. An infection caused by an endoscopy procedure may require antibiotics.
• Tearing of the gastrointestinal tract. A tear in your esophagus or another part of your upper digestive tract may require hospitalization, and sometimes surgery to repair it.

You can reduce your risk of complications by carefully following your doctor's instructions for preparing for endoscopy, such as fasting and stopping certain medications.

Signs and symptoms that could indicate a complication
Signs and symptoms to watch for after your endoscopy include:

• Fever
• Chest pain
• Shortness of breath
• Black or very dark colored stool
• Difficulty swallowing
• Severe or persistent abdominal pain
• Vomiting

Call your doctor immediately or go to an emergency room if you experience any of these signs or symptoms.

How you prepare

Your doctor will give you specific instructions to prepare for your endoscopy. In some cases your doctor may ask that you:

• Fast before the endoscopy. You may be asked to stop drinking and eating six to eight hours before your endoscopy. This is to ensure your stomach is empty for the procedure.
• Stop taking certain medications. You may be asked to stop taking certain blood-thinning medications in the days before your endoscopy. Blood thinners may increase your risk of bleeding if certain procedures are performed during endoscopy. If you have chronic conditions, such as diabetes, heart disease or high blood pressure, your doctor will give you specific instructions regarding your medications.

Tell your doctor about all the medications and supplements you're taking before your endoscopy.

Plan ahead for your recovery
Most people undergoing endoscopy will receive a sedative to make them relaxed and more comfortable during the procedure. If you'll be sedated during the procedure, plan ahead for your recovery. For instance, find someone to drive you home since it won't be safe for you to drive. You may also need to take the day off from work.

You may feel mentally alert after receiving a sedative, but your memory, reaction times and judgment may be impaired. Planning ahead for this can help keep you safe while the sedative wears off. Additionally, don't make any important personal or financial decisions for 24 hours.

What you can expect

During endoscopy
During your endoscopy procedure, you'll be asked to lie down on a table on your back or your side.

Monitors often will be attached to your body to allow your health care team to monitor your breathing, blood pressure and heart rate during the procedure. You may receive a sedative medication through a vein in your arm. This medication helps you relax during the endoscopy.

Your doctor may spray an anesthetic in your mouth to numb your throat in preparation for insertion of the long, flexible tube (endoscope) that will be used to see your digestive tract. You may be asked to wear a plastic mouth guard to hold your mouth open. Then the endoscope is inserted in your mouth. Your doctor may ask you to swallow as the scope passes down your throat. You may feel some pressure in your throat, but you shouldn't feel pain.

You can't talk after the endoscope passes down your throat, though you can make noises. The endoscope doesn't interfere with your breathing.

Your doctor then passes the endoscope down your esophagus toward your stomach. A tiny camera on the end of the endoscope transmits images to a video monitor in the exam room. Your doctor watches this monitor to look for abnormalities in your upper digestive tract. If abnormalities are found in your digestive tract, your doctor may record images for later examination.

To help the endoscope move through your upper digestive tract, gentle air pressure may be fed into your esophagus. This inflates your digestive tract so the endoscope can move freely and the folds of your digestive tract are more easily examined. But the air can also create a feeling of pressure or fullness.

If there's a need to collect a tissue sample or remove a polyp, your doctor will pass special surgical tools through the endoscope. Your doctor watches the video monitor to guide the tools.

When your doctor has finished the exam, the endoscope is slowly retracted through your esophagus and back out through your mouth. Endoscopy typically takes five to 20 minutes, depending on your situation.

After endoscopy
You'll be taken to a recovery area to sit or lie quietly after your endoscopy. You may stay for an hour or so, depending on your situation. This allows your health care team to monitor you as the sedative begins to wear off.

Once you're at home, you may experience some mildly uncomfortable signs and symptoms after endoscopy, such as:

• Bloating and gas
• Cramping
• Sore throat

These signs and symptoms will improve with time. If you're concerned or quite uncomfortable, call your doctor.

Take it easy for the rest of the day after your endoscopy. You may feel alert, but your reaction times and judgment are delayed after receiving a sedative.

Results

When you receive the results of your endoscopy will depend on your situation. If, for instance, your doctor performed the endoscopy to look for an ulcer, you may learn the findings right away after your procedure. If your doctor performed an endoscopy to collect a tissue sample (biopsy), it may be several days until results from laboratory testing are available. Ask your doctor when you can expect the results of your endoscopy.