An upper endoscopy, sometimes referred to as esophagogastroduodenoscopy or EGD, is a type of endoscopy performed on the upper GI tract. This procedure is considered the golden standard for identifying certain gastrointestinal disorders such as celiac disease.
Unlike its lower GI tract counterpart, colonoscopy, an endoscopy doesn’t require patients to prepare with a cleanse. A clear liquid diet is usually enough to ensure the exam’s success. This procedure is currently being used to diagnose anything from stomach cancer to ulcers and is an integral part of maintaining one’s upper GI health.
So, are upper GI endoscopies necessary? This depends on your case. Some patients might benefit from blood tests and imaging services, while others might require a definitive visual diagnosis from an upper GI. This is especially true for GI disorders that involve structural abnormalities such as stomach cancer (even in its early stage) and peptic ulcer.
Before getting an upper endoscopy, it’s important to understand crucial information that will help you prepare for the procedure. In this article, we discuss everything from costs, to risks, to aftercare in order to prepare for a comfortable and successful upper GI.
Introduction to the Upper GI
The upper GI (upper gastrointestinal tract) refers to the organs and mechanisms in the upper tract of the gastrointestinal system. The distinction “upper” and “lower” exists to allow medical professionals to easily identify the site of an abnormality, for example, gastrointestinal bleeding.
The organs in the upper GI are:
- Mouth: The mouth is the entryway of food to the digestive tract. Enzyme-containing saliva is released during food intake to help break down carbohydrates. When swallowed, food travels down the pharynx and into the esophagus
- Pharynx: The pharynx is a membrane that connects the nose and mouth to the esophagus. Its primary role is to serve as a pathway for food as it travels down the esophagus.
- Esophagus: The esophagus is a hollow tube that extends from the pharynx to the stomach. A “valve” called the lower esophageal sphincter serves as a door that allows food to enter the esophagus, while ensuring that the stomach contents aren’t regurgitated back up. However, this valve can malfunction, leading to a condition called acid reflux.
- Stomach: The stomach receives ingested food and continues to digest it by releasing acids and enzymes to further break down the food. The stomach secretes acids to aid with digestion and kill any residual bacteria from food and drink, and mucus to protect the stomach lining.
- Duodenum: The duodenum is the first section of the small intestine. Here, nutrients are absorbed and food is further digested. As the food passes through the duodenum, secretions from the pancreas and Brunner glands are triggered to neutralize the acid and protect the small intestine.
Upper GI Complications
Disorders concerning the upper GI are common. Upper GI complications can arise due to a variety of reasons, creating alarming symptoms that could cause anxiety, pain, and reduced quality of life.
For instance, gastro-esophageal reflux disease (GERD) affects about 20% of the U.S. population and is considered one of the most common chronic gastrointestinal diseases.
The stomach functions best when the stomach lining called mucosa is able to maintain a balance between acid and mucus secretion. When disrupted, this can lead to ulcers, erosion, and even tumor. The American Cancer Society predicts that 27,510 cases of stomach cancer will be diagnosed in 2019, with less than half of those patients reaching mortality.
Although alarming, upper GI disorders are now easily managed thanks to advanced screening methods such as endoscopy.
Overview on Upper GI Endoscopy
Understanding the nature of your upper GI is made possible through a sophisticated method of visual examination. Through an endoscopy, medical specialists can clearly observe the location and condition of an ulcer, growth, infection, or any other GI abnormality.
What Is an Upper GI Endoscopy?
An endoscopy (also called an esophagogastroduodenoscopy or EGD) is a procedure that uses a viewing tool called an endoscope. The endoscope is a thin, flexible tube inserted through the mouth and is gently moved down to inspect the throat, stomach, and duodenum. This tool is equipped with a camera and a small flashlight, which projects images onto a computer. Some endoscopes are equipped with a colored light to aid in the detection of precancerous conditions. This is referred to as narrow band imaging.
Upper GI Fluoroscopy VS Endoscopy
CT scans, ultrasounds, and other imaging techniques are also a viable method of diagnosis. For diagnosing abnormalities concerning the upper GI tract, a specialized x-ray called fluoroscopy is used in order to study everything from the esophagus to the duodenum. A contrast material such as barium is ingested which allows the scan to reflect the inside of the body using minor exposure to radiation.
Fluoroscopy is performed to detect ulcers, tumors, and inflammation. It is usually recommended after an ultrasound or x-ray has detected an abnormality that needs further probing. Unlike regular x-rays, fluoroscopy uses radiation imaging to examine the GI tract.
Unlike an endoscopy, fluoroscopy is a non-invasive procedure. At most, the patient is required to take the contrast material and to restrict diet and relevant medication in order to produce the best results.
Fluoroscopy is useful in detecting clearly visible large ulcers. Infections such as those caused by the bacterium Helicobacter pylori may also be detected. However, additional tests are required in order to confirm the bacterial presence.
Despite its many uses, fluoroscopy is unable to localize abnormalities and detect smaller growth in the GI tract. On the other hand, an upper endoscopy gives doctors complete visuals of the GI tract, making for a more accurate diagnosis. During an endoscopy, doctors may also perform a biopsy for further study or complete tissue removal. Results are sent back to a lab where pathologists can determine whether the cells are precancerous or show strains of bacterial infection.
Upper Endoscopy VS Colonoscopy
A colonoscopy is performed to observe the colon, which is found in the lower part of the gastrointestinal tract, whereas an upper endoscopy is performed to observe the esophagus, stomach, and duodenum – all found in the upper GI tract.
A colonoscopy is a procedure that also involves an endoscope to investigate the colon. This procedure is done to evaluate symptoms such as rectal bleeding, changes in bowel habits, constipation, and abdominal pain.
Unlike colonoscopy, an upper endoscopy doesn’t require bowel cleansing. Although patients are required to undergo a clear diet, patients undergoing an upper endoscopy don’t have to take any laxatives to clean out the upper GI tract.
Individuals 50 years old and above are at above-average risk for colon cancer. As such, a colonoscopy is encouraged for all adults, especially for individuals who are more predisposed to developing colon cancer due to genetics and medical history.
Read more: Is Colonoscopy Necessary for Everyone?
Meanwhile, there is no recommended age for upper GI screening. An upper endoscopy will be recommended to a patient once crucial signs and symptoms show.
Reasons For Upper GI Endoscopy
An upper endoscopy may be recommended to satisfy the following:
1. Diagnose Diseases
Doctors may perform a biopsy, a process involving the removal of tissue samples, in order to test for diseases. Bleeding, inflammation, blood loss, and irregular bowel movements can be a cause for concern, especially when these signs are accompanied by other symptoms and worsen with time. As such an endoscopy is performed to diagnose abnormalities in the gastrointestinal tract and rule out the possibility of diseases.
2. Investigate Symptoms
Persistent symptoms, both related to digestion and food consumption, can point to problems in the GI tract. As such, an upper endoscopy is performed to locate the source of the problem. The most common symptoms that prompt an upper GI endoscopy are:
- Persistent stomach, abdominal, or chest pain
- Difficulty swallowing
- Bloating and discomfort after eating
- Ulcer, gastritis, high levels of acidity
- Inconsistent bowel habits
- Chronic constipation
- Heartburn or acid reflux
3. Treat Disorders and Diseases
An upper GI endoscopy can also be used as a treatment tool. After discovering an abnormal growth or polyp along the upper gastrointestinal tract, an endoscopy may be performed to remove the polyp from the stomach lining to prevent the polyp from morphing into cancerous growth. An upper GI endoscopy can also be used to treat conditions such as bleeding from ulcers.
An upper GI endoscopy can also be used to aid in other treatment methods. For patients with benign esophageal stricture (narrowing of the esophagus), the treatment called esophageal dilation is performed during an endoscopy.
What Can Upper GI Endoscopy Detect?
An upper GI endoscopy is useful in treating various disorders affecting the gastrointestinal tract. These include:
1. Blockages and other structural problems
Patients suffering from an obstruction in the GI tract may experience nausea, vomiting that contains food and drinks, and constipation. Obstructions can appear on the GI tract as a result of growths blocking food and fluids from passing through the gastrointestinal system.
Blockages are common in patients with esophageal and stomach cancer. As such, an upper endoscopy can confirm the presence of a blockage. When found, doctors may perform surgery to remove the obstruction along the GI tract.
Ulcers are sores that appear on the lining of the stomach and small intestine. Peptic ulcers are ulcers localized in the upper GI, which includes gastric ulcers (stomach ulcers) and duodenal ulcers (ulcers located in the duodenum).
Common causes for ulcers include the presence of the bacterium Helicobacter pylori and long-term overuse of NSAIDs. Patients usually report feeling stomach pain, intolerance to fatty foods and drinks, and heartburn.
An endoscope is performed to confirm the presence of an ulcer. Doctors may recommend performing a biopsy in order to rule out the H. pylori bacterium as the cause for the ulcer.
3. Gastroesophageal Reflux Disease
Chronic acid reflux and heartburn are characterized as gastroesophageal reflux disease or GERD. Acid reflux occurs when the lower esophageal sphincter malfunctions, allowing stomach contents to travel back up the esophagus, sometimes reaching the mouth.
Patients with GERD report bile-tasting acid traveling back up the esophagus, which can often irritate the esophagus lining. As such, an endoscopy can be instrumental in diagnosing GERD.
In an attempt to identify GERD, the endoscopist will be looking for acidic damage along the esophagus lining, as well as hernia and other physical abnormalities. More importantly, doctors will keep an eye out for the symptoms of Barett’s esophagus, a complication that is associated with a higher chance of developing esophageal cancer.
Individuals with GERD might experience esophageal narrowing due to prolonged exposure to acid damage. In the event of esophageal narrowing, doctors may perform esophageal dilation (or the stretching of the esophagus) as part of the endoscopy.
4. Stomach Cancer
An upper endoscopy is a definitive test in identifying stomach cancer. Used both as a diagnosis and a screening tool, an upper endoscopy may help doctors distinguish cancerous lesions from normal lesions.
In its early stages, stomach cancer appears as small and subtle lesions on the stomach lining. Alternatively, stomach cancer may also appear like an ulcer with visible mass or flat parts. Even without the use of other imaging methods, doctors with a trained eye can identify pre-cancerous tissue just by evaluating its structure alone.
5. Celiac Disease
Celiac disease is a disorder wherein the body is unable to process gluten. As an immune system response to gluten, patients experience inflammation and minor intestinal damage. A blood test is the go-to method for identifying celiac disease. However, test results can sometimes come out inaccurate, at which point an endoscopy would be recommended by the doctor.
Small finger-like tissues called villi exist in the small intestine. Individuals with celiac disease usually have fat villi, caused by the body’s adverse reaction to gluten. As such, endoscopists investigate the small intestine and observe whether the villi is flattened or in normal shape.
When Is Upper GI Endoscopy Not Useful?
Despite its many benefits, an upper GI endoscopy may not be beneficial for patients with the following conditions:
- Organ perforation in the upper GI tract
- Diagnosing or treating irritable bowel syndrome
- Acute diverticulitis
- Colon inflammation
- Severe gastrointestinal bleeding
- Severe upper GI bleeding
- Coronary artery disease or any other heart-related disorder
- Bleeding in the abdomen caused by torn blood vessel
Who Performs an Upper Endoscopy?
An upper endoscopy is routinely performed by a gastroenterologist. A surgeon or any other trained medical professional may also perform an upper GI endoscopy. This procedure is usually done in a doctor’s office, hospital, or gastrointestinal clinic.
Understanding the Procedure
Upper GI endoscopy involves various components that contribute to its success. Knowing key information about the procedure will help you prepare for your upper endoscopy, ensuring accurate results.
Before the Procedure
Patients should inform doctors regarding medical history, medicine use, and family medical history. These variables are important in deciding whether an upper endoscopy is the best screening or diagnostic method for the patient. Medications that may interfere with the test will be suspended.
Minor fasting is involved in an upper endoscopy. Patients will be required not to eat or drink 8 hours before the test to ensure test accuracy. Only clear liquids such as water, clear juice, broth, and coffee and tea without cream are allowed. As with a colonoscopy, foods with dye are to be avoided. The use of NSAIDs and blood-thinning drugs before an upper endoscopy is also prohibited. No laxatives and preparations are necessary.
A sedative is usually administered during the procedure, typically through an IV line, to help patients relax during the procedure. Arrange a ride home after the procedure. Some medical centers would go as far as to not let patients have the procedure until they prove they have a designated driver.
During the Procedure
An upper endoscopy is an outpatient procedure that is typically performed in 30-60 minutes. During the procedure, doctors will administer sedatives to minimize discomfort and allow relaxation. Doctors may spray an anesthetic to numb the throat in preparation for the endoscope. A mouth guard may be applied to help keep the mouth open.
Although endoscopy is a painless procedure, it’s normal to feel some pressure in the throat as the tube makes its way down the upper GI. The gastroenterologist may instruct you to swallow during the exam.
The endoscope will project images of your upper digestive tract onto a computer. The doctor will be using this to investigate any symptoms and understand the cause of any abnormality. During an endoscopy, the gastroenterologist may gently inflate your digestive tract in order to navigate the tract more freely.
Complications and Risks
Although uncommon, gastrointestinal tearing can occur during an endoscopy. This happens when the endoscope damages the gastrointestinal lining, which could lead to hospitalization. The risk of GI perforation increases when other procedures are performed alongside the endoscopy, such as esophagus dilation.
Contamination on endoscopes is possible without proper disinfection and sterilization methods. Bacteria may form on the surface of the endoscope and can be transferred from one patient to another. Despite this, infections from endoscopies can easily be treated with antibiotics. Ask your doctor about preventive antibiotics before the procedure so you don’t have to worry about contracting a bacterial infection.
Bleeding from an endoscopy may be caused by a biopsy or any other accompanying procedure. A blood transfusion might be necessary in the event of bleeding. However, this is extremely rare and unlikely to happen in standalone upper endoscopies.
Allergies and Sensitive Reactions
Negative reactions to sedatives and anesthesia are possible. It’s important to talk to your doctor about any known allergies to mitigate the risk of complications during the procedure itself. If applicable, discuss your previous surgical history and note instances of allergic or severe reactions to anesthetics and sedatives.
Things to Watch Out For
Dizziness and disorientation is normal within 24 hours after the procedure. Get in touch with a medical professional if a patient is exhibiting the following problems following an upper endoscopy:
- Black, tarry, stool or any other unusual bowel appearance
- Heart palpitations and shortness of breath
- Vomiting, with blood or without
- Severe chest pain
- Unusual abdominal pain
- Gastrointestinal bleeding
- Discomfort in the throat
- Pain during swallowing
- Difficulty breathing
Cost and Insurance
Costs on upper endoscopy vary depending on a patient’s gastroenterologist, city, and facility you are doing it in. On average, an upper endoscopy can cost anywhere from $1,200 to $3,300. This usually includes sedative, anesthetic, and doctor’s fees.
Coverage for endoscopies depend on your healthcare plan. Get in touch with your insurance provider and ask whether or not a gastrointestinal endoscopy is covered in your plan.
After the Upper GI Endoscopy
Common Side Effects, Recovery, and After Care
Doctors may ask you to stay in the medical facility 1-2 hours after the procedure as the sedative wears off. Patients are allowed to leave the hospital after an endoscopy, but will be instructed to rest at home within the day. Avoid any physical activities throughout the day and allow the sedative to wear off completely.
We recommend easing into your normal diet at least 24 hours after the procedure. After that, you are free to consume your normal meals. Keep in mind that a sore throat is a common side-effect of endoscopy and will go away in a matter of days. Bloating and nausea are other common side-effects.
How Long Do Results Take?
Results are typically available 1-2 days after the examination. Additional days may be required if a biopsy was performed alongside the endoscopy. You will get a call from your gastroenterologist asking you to come back to the clinic to discuss the results once a final report has been sent.
Understand the State of Your Upper GI
Your upper gastrointestinal tract is a crucial part of the digestive process. At Gastro Center in New Jersey, we are equipped with the latest tools and techniques to make your upper endoscopy a comfortable experience.
Worried about some symptoms? Book an appointment with us today and get the answers you’ve been waiting for.