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If you ever visit a gastroenterologist or surgeon with a recurrent digestive issue, you may be recommended to have an upper endoscopy procedure. Most people think of endoscopy as an uncomfortable, painful procedure where a tube is stuffed down their throat- the very image of the procedure makes them ask for all sorts of alternatives. However, this procedure is a wonderful tool that specialists rely on to diagnose and sometimes treat the upper part of your digestive system including the esophagus, stomach, and the beginning of the small intestine. 

In this blog, we will discover more about this procedure that will put your mind at ease and also learn about five conditions that can be identified (and sometimes treated) with the help of endoscopy. 

Understanding endoscopy 

In medical terms, an upper endoscopy is called an esophagogastroduodenoscopy and is done in your gastroenterologist’s or surgeon’s office on an outpatient basis. Generally, the endoscope consists of a tiny camera on the end of a long flexible tube. For additional procedures, different probes and/or tools are attached to this tube and inserted down your esophagus into your digestive system. 

All endoscopy procedures are done under some degree of sedation which helps relax you and subdues your gag reflex. The sedation will usually put you into a moderate to deep sleep, leaving you with no pain or memory of the endoscope being inserted through the mouth and into your digestive tract. 

When will your gastroenterologist or surgeon recommend an endoscopy procedure? Usually, the procedure is recommended under four circumstances- 

• To investigate certain symptoms, an endoscopy is a particularly helpful tool. Recurring symptoms like nausea, vomiting, difficulty in swallowing, and abdominal pain and/or bleeding can be investigated better through this procedure. 
• To improve the diagnosis, specialists may be required to collect tissue samples for biopsy, which can be done with the help of an endoscope. Testing the tissue sample will help understand the reason for conditions like anemia, bleeding, diarrhea, inflammation, and/or cancers of the digestive tract. 
• Gastroenterologists and oncologists may also use endoscopy to correct issues of your digestive system such as internal bleeding, to widen a narrow esophagus, remove a foreign object or a polyp. 
• Endoscopic ultrasound can be performed by attaching an ultrasound probe to the endoscope. These will give high-definition images or videos of the patient’s internal organs, such as the pancreas. 

Endoscopy – procedure and complications 

During the procedure, your doctor and endoscopist will help you relax and be ready for the procedure. You will be lying down on a table on your back or side. You will have monitors attached to various parts of your body, which will check your blood pressure, heart rate, and breathing. Once you are ready, you will be sedated via an intravenous injection. Your doctor will also spray an anaesthetic into your mouth, following which a mouth guard is used to hold your mouth open. The endoscope is then inserted into your mouth. Although you may feel some pressure, the procedure is not at all painful. 

As the endoscope passes through your digestive tract, a camera will transmit images to a video monitor in the exam room. This allows your doctor to look for abnormalities in the upper digestive tract. Additional surgical tools may be passed through the endoscope to collect tissue samples or remove the polyp. The video monitor will help your doctor guide the tools. The procedure typically lasts 15 to 30 minutes depending upon your situation, after which the endoscope is retracted out. 

Following your doctor’s instructions will greatly reduce your chances of encountering complications before, during, and after an endoscopy. These instructions include- 

• Fast for four to eight hours before the procedure to ensure an empty stomach. 
• Stop taking blood-thinning medications in the days leading to the procedure to reduce the risk of bleeding. 
• If you take any other medications/supplements, let the doctor know so that he can give you specific instructions for the same. 
• Plan for an endoscopy procedure by having someone drive you back after the endoscopy procedure. As you recover from the endoscopy procedure, while the sedative wears off, you may not be as mentally alert and ready as you wish. 
• While resting in the recovery area, note any uncomfortable signs and symptoms you may have. 
• Take leave and rest the day of your endoscopy. Don’t make any decisions during the recovery period as your reaction time and judgment may be affected as a result of the sedation. 

Although endoscopy is generally a very safe procedure, complications may occur rarely. These include- 

• Bleeding is a possible complication of an endoscopy procedure, especially if this involves sample collection or polyp removal. 
• The risk of infections is minor, although possible. If you are at higher risk of infection after an endoscopy, your doctor may prescribe preventive antibiotics. 
• A tear in the intestinal tract after an endoscopy is extremely rare. However, if it happens, you may require hospitalization and possible surgery to repair it. 

After the procedure, you may experience some gas, bloating, or sore throat. However, if your endoscopy procedure leads to a complication, it will be indicated by symptoms such as fever, chest pain, shortness of breath, blood in stool, persistent abdominal pain, vomiting, and difficulty in swallowing. If you experience any of these signs following the procedure, visit an emergency room immediately.  

Conditions diagnosed by endoscopy 

Your gastroenterologist or surgeon recommends an endoscopy procedure to help them diagnose a range of diseases and conditions. Here are some of them- 

• Gastroesophageal reflux disease 

Gastroesophageal reflux disease or GERD is a condition when gastric acid flows backward from the stomach into the esophagus, thereby damaging the lining of the esophagus. The long-term symptoms include heartburn, indigestion, regurgitation, and nausea. Chronic GERD often leads to another condition called the Barrett Esophagus which is the abnormal cell growth in the esophagus, which may lead to cancer. Performing an endoscopy will help diagnose the condition and collect tissue for biopsy in the case of Barrett’s Esophagus. 

• Inflammation or ulcers 

Unexplained nausea, vomiting, belching, bloating, and stomach pain could be indicators of inflammations in the digestive tract. Long-term inflammation may erode the inner lining of the intestinal tract causing ulcers. An endoscopy will help confirm the diagnosis.  

• Esophageal stricture 

An esophageal stricture is the narrowing of the esophagus, blocking the normal passage of food and liquids into the stomach. This causes larger pieces of food to get stuck. GERD, tumors, or polyps causes this stricture. Patients experiencing esophageal stricture may experience difficulty in swallowing, shortness of breath, chest pressure, and vomiting. 

Through endoscopy, doctors can diagnose and treat the condition. Minor, non-malignant growths can be expertly removed and stents can be placed to widen the esophagus for normal passage of food. 

• Esophageal varices 

Esophageal varices are enlarged veins in the walls of the esophagus that are at risk of rupture and bleeding. If the varices rupture, the patient may vomit blood or have black tarry or bloody stools. Usually, bleeding is the only sign of an issue. Blood loss through vomit or stool can be life-threatening. 

An upper endoscopy will help confirm the diagnosis and prevent serious issues. The varices can also be appropriately treated during the procedure. 

• Tumors and cancer 

Unusual ulceration, abnormal growth, and masses in the upper gastrointestinal tract require an endoscopy to understand more about them. Tissue samples collected from the tract are sent for biopsy to rule out malignancy. Some of these growths may be benign (noncancerous) and can be easily removed during the endoscopy procedure itself. However, the presence of cancerous cells will require further treatments under the instruction of an oncologist. 

The most common cancers seen in the upper digestive system are stomach cancer and esophageal cancer. Symptoms include nausea, vomiting, unexplained anemia, and pain while swallowing. People with long-term gastritis or those with a family history of cancer are at higher risk of contracting intestinal cancer. 

Takeaway 

Endoscopy is a safe, painless, and highly effective procedure that can be used for diagnosing and treating issues concerning the upper digestive tract. If you are recommended to undergo an endoscopy, keep your unnecessary fears away and prepare for the procedure on the instruction of your doctor. 

 Are you experiencing any of the symptoms discussed in this blog? Then book an appointment with Dr. Antonio Privitera, one of the best gastroenterologists and proctologists in Dubai.