Upper Digestive Endoscopy: what it is, how it is done, preparation

What is?

Upper gastrointestinal endoscopy, esophagogastroduodenoscopy or popularly known only as endoscopy, is an examination that allows the upper part of the gastrointestinal tract, made up of the esophagus, stomach and duodenum (initial part of the small intestine) to be viewed through a camera.

Referral for ordering the exam is quite common when patients complain of pain in the stomach area and the beginning of the small intestine.

Although it frightens most people, because it is a procedure that introduces the endoscope, the endoscopy does not hurt and produces the least possible discomfort, since it is done under sedation.

In addition, the examination is usually quite complete, so its results are able to point out different directions of a possible disease, such as its location, category and also the degree of intensity

What is it for?

The test is commonly requested to diagnose or treat diseases that affect the upper digestive system, which may show symptoms such as: persistent abdominal pain, nausea, vomiting and / or difficulty swallowing.

This test may also be required to remove objects that may have been swallowed accidentally, or it can be used to perform biopsies of the mucosa of the esophagus, stomach or duodenum, in order to detect diseases and conditions.

Therapeutic uses

Digestive endoscopy is also a widely explored procedure for therapeutic use in other diseases. It is considered a good method, because in addition to being minimally invasive, it does not require incisions in the abdominal region. Check out how it can be used:

  • Placement of an intragastric balloon for the treatment of obesity;
  • Placement of probes in patients with difficulty in swallowing;
  • Perform gastrostomy (surgical intervention for placement of a food probe);
  • Removal of polyps (polypectomies);
  • Elastic ligation / sclerotherapy of esophageal varices;
  • Removal of foreign bodies (coins swallowed by children, for example);
  • Treatment of bleeding lesions (ulcers, vascular lesions, tumors, etc.);
  • Dilatation of strictures (of the esophagus, stomach or duodenum).

How is it done?

Endoscopy is a very safe and simple test, lasting 10 to 20 minutes. The exam consists of 2 small steps: sedation and the introduction of the endoscope.

Sedation

In reality, sedation is a step that precedes the procedure. As soon as the patient enters the examination room, he will be instructed to lie on his side. Then a spray will be used in the throat, in order to anesthetize the region, so the vomiting reflex is avoided.

Shortly afterwards, a short-term sedative is also applied, usually intravenously, so that the patient does not experience any type of discomfort with the introduction of the endoscope.

How is sedation done?

The main objective of sedation is to prevent the patient from feeling pain and discomfort during the procedure.

For this to happen, two medications can be used: Midazolam or Propofol . Both act on the central nervous system, more specifically on the activating reticular system, which is responsible for keeping us awake or asleep.

Thus, they stimulate the sensation of drowsiness and sleep, in addition to, at the same time, also affecting another region: the limbic system, which is responsible for emotions.

Thus, sedation also stimulates the feeling of well-being, and it is common to report these feelings of relaxation when the patient wakes up.

Endoscope introduction

After the patient is completely sedated, which usually happens very quickly, the exam is actually started. The doctor, usually a gastroenterologist , introduces the tube, which is super flexible, through the mouth. The endoscope has a camera at its end, so right after the introduction, the doctor is guided by the images.

The images recorded by the camera are transmitted in real time to a monitor that is next to the doctor, so the professional is not only guided, but can also identify changes in the mucous membranes of the esophagus, stomach and duodenum.

In case the doctor finds suspicious lesions, it is possible that a biopsy will be performed, that is, small pieces of mucosa will be removed, in a totally painless process, so that, next, a pathologist will be able to evaluate the sample.

Throughout the examination, bloody lesions can also be found. If this is the case, the professional can cauterize the site so that the bleeding is contained. In the examination, it is still possible to remove objects that have been accidentally swallowed.

During the procedure, it is also common for the introduction of air to be necessary. It will be responsible for “ungluing” the walls of the organs that are very close together and, thus, it will facilitate the internal visualization. This introduction of air is done by the endoscope itself, which already has such a mechanism.

Does endoscopy hurt?

Because it is an exam that is performed under sedation, endoscopy does not hurt . The patient may experience slight discomfort in the throat after the procedure, but it should go away in the first few hours.

When should be done

This type of examination is usually requested by the gastroenterologist after the patient complains of stomach pains, difficulty or pain in swallowing, burning, vomiting or any discomfort in regions where the organs of the digestive system are located.

Its performance can help to identify the reasons for symptoms without a definite cause, including persistent heartburn , difficulty in swallowing and bleeding.

In addition, the test may also be ordered for people who have a family history of stomach cancer or conditions that lead to the onset of the disease.

The procedure may still be required to detect the presence of the H. pylori bacterium , although there are other, less invasive methods that may or may not confirm the suspicion.

In addition to those already mentioned, there are also other reasons why it is indicated that, although less recurrent, are just as common as the others:

  • Investigate unexplained pain or discomfort in the upper abdomen;
  • Assess the severity of gastroesophageal reflux disease, which does not respond to initial clinical treatment;
  • Track cancer in patients with a previous diagnosis of Barrett’s esophagus;
  • Investigate persistent nausea and vomiting;
  • Assess and possibly treat bleeding from the upper gastrointestinal tract (such as vomiting with blood or signs of digested blood in the stool, suggesting the stomach as the cause);
  • Investigate esophageal varices in patients with cirrhosis and / or portal hypertension;
  • Investigate cases of iron deficiency anemia without a definite cause;
  • Investigate difficulties in swallowing food or feeling of food stuck in the esophagus;
  • Remove a foreign body accidentally swallowed;
  • Investigate weight loss for no apparent reason;
  • Investigate the possibility of the patient having celiac intolerance;
  • Assess the severity of esophageal injury in patients who have ingested caustic soda, bleach (bleach) or any other corrosive substance;
  • Evaluate the cure or evolution of polyps, tumors or ulcers found in previous endoscopies.

Contraindications

There is no contraindication for the exams. However, patients who have respiratory, neurological or cardiac problems should inform their doctors.

In addition, patients with a history of allergy to medications should also be alert and inform the health professional.

Preparation

The main recommendation that must be followed before the exam is performed is not to eat in the 4 to 8 hours before the procedure time .

Thus, the stomach will be empty, preventing the patient from vomiting. This also facilitates the doctor’s vision, without the presence of food scraps.

For patients using medication for continuous use, it is always important to inform the laboratory and clinic where the exam will be performed, at the same time of the appointment. Check out what these medications are:

  • Aspirin or those that have aspirin in their composition;
  • Arthritis and diabetes medications;
  • Blood pressure regulators;
  • Blood thinners;
  • Anti-inflammatories, like ibuprofen .

In this way, they will be able to inform whether or not there will be a need to change the medication administration.

It is also not recommended that the patient take antacids, as they are able to change the pH of the stomach, which can interfere with the test result.

In addition, the presence of a companion is essential for the examination, including it will only start when the other person is at the location.

This requirement occurs because the sedative used in the procedure can cause some effects.

Post-examination effects

As one of the stages of the exam is sedation, most post-exam sensations are related to it.

After the end of the procedure, the patient usually waits between 20 and 30 minutes, in a room, until he wakes up and the effects of sedation are already lessened.

As soon as the patient wakes up, a slight feeling of tiredness or lack of concentration can be felt. Both are sensations that will be mitigated as time goes by.

It is also common to have total amnesia in relation to the exam, even patients often do not believe that they have already undergone the procedure.

Although the effects of anesthesia are mild, the medication can still continue to take effect for up to 8 hours. Therefore, after the exam the person is not able to drive, work or make important decisions.

Some sensations can still manifest after the pain-relieving effect of the spray is gone, such as a mild sore throat . Certain patients also experience abdominal distention, a result of the air that may have been introduced during the examination.

There are other guidelines that are normal after the procedure:

  • Wait for the effect of anesthesia, in the place where the procedure was performed, for a time that can vary from 30 minutes to 2 hours, or as the doctor deems necessary;
  • Rest at home, after the exam;

Symptoms such as discomfort or vomiting in the first few hours after endoscopy are also relatively common.

Results

As upper gastrointestinal endoscopy is an exam that analyzes 3 organs, there are many possibilities for results. However, the most common request occurs from suspected gastritis .

Sometimes, the results of the procedure can be given immediately, although the official report takes a few days to be released, especially those that need a biopsy.

The results always have 3 parameters, established by the Sydney system: topography, category and degree of intensity.

Topography

This parameter focuses on pointing out which region of the stomach gastritis is affecting:

  • Pangastritis: gastritis is spread throughout the stomach;
  • Antrum gastritis : gastritis is located only in the antrum (the final part of the stomach);
  • Gastritis of the body: gastritis is located in the central region of the stomach.

Category

There are 7 categories of gastritis, which relate to the type of injury it causes:

  • Enanthematous: presence of red rashes in the region where the gastritis is located;
  • Erosive: there are erosions in the mucosa, which may be flat or elevated. It usually precedes the formation of ulcers;
  • Atrophic: chronic inflammation of the stomach lining, resulting in the loss of cells that form the glands that produce gastric juice. With that, there is a replacement of the cells of the stomach for cells of the intestine;
  • Hemorrhagic: there is bleeding in the stomach, and the patient also has symptoms such as bloody vomiting, dark stools, pressure drop and pallor;
  • Reflux (alkaline reflux or bile reflux): reflux from the duodenum reaches the stomach, causing a chronic lesion of the mucosa;
  • Hyperplastic: significant increase in the number of cells, in some layer of the stomach, resulting in an enlargement or greater height of the gastric folds. It is usually associated with other diseases, such as Ménétrier’s disease or Zollinger-Ellison syndrome.

Degree of intensity

In the exam, you can also find out the degree of intensity of your gastritis:

  • Light;
  • Moderate;
  • Severe

This nomenclature indicates what stage the disease is in or how long it has been installed in your body.

What can affect the results?

At first, there is no medication that can affect the results of the endoscopy exam.

What will be critical to a clear exam result is how it was done. The professional needs to be very attentive to the images so as not to miss any different texture or coloring, for example.

It is worth remembering that the exam must always be done by a gastroenterologist or an endoscopist, as these professionals are trained both to perform the exam and to understand the images captured by the endoscope.

Scratchs

Endoscopy is considered an extremely safe test, with minimal risks. Symptoms that may indicate a problem include fever , difficulty swallowing, pain in the chest or abdomen and vomiting. Among the possibilities of complications are:

Reaction to sedatives

If you use any constant medication or are allergic to any medication, it is always important to inform your doctor or when scheduling the exam.

It is also important to inform if you have a disease that causes respiratory, cardiac or neurological problems.

Some possible effects caused by sedatives are:

  • Difficulty breathing;
  • Excessive sweating;
  • Low blood pressure;
  • Slow heartbeat (bradycardia);
  • Spasm of the larynx.

Bleeding and perforation

There is still a minimal risk of bleeding when a biopsy is required during the exam.

There are also a few cases of perforation of the esophagus, stomach or duodenum, which should be treated with the patient’s hospitalization.

Infections

There is a risk of the patient contracting infections during the procedure. In general, the possibility is minimal and the infection can be treated with antibiotics .

Price

The upper gastrointestinal endoscopy exam is available by both SUS and most health plans. The price of the exam in private clinics can vary between 150 and 200 reais.

Some places have a different price when the biopsy needs to be done.

Complementary exams

In addition to upper digestive endoscopy, which, as already mentioned, is restricted to the care of the upper digestive tract, there are other tests that also investigate diseases located in the digestive system:

Colonoscopy

colonoscopy is an examination characterized by observation of other organs of the digestive system, as the final part of the small intestine and the entire large intestine. Because of this, it is also considered a digestive endoscopy exam.

Like endoscopy, colonoscopy occurs with the sedated patient, but the introduction of the flexible tube, which in this case is the colonoscope, occurs through the anus.

Endoscopic Ultrasound

This exam is requested to investigate diseases in the walls of the stomach, nearby tissues and lymph nodes.

Often, endoscopy is a part of the endoscopic ultrasound examination, which is characterized by the use of sound waves capable of producing images in real time.

Enteroscopy

Enteroscopy is an exam used to investigate diseases of the gastrointestinal tract, especially the small intestine. In it, an enteroscope is used and there is a collection of fragments of the mucosa.

Common questions

Can pregnant women do endoscopy?

Although the examination itself does not pose any risk to the pregnant woman or the baby, endoscopy should only be performed if there are suspicions of diseases that threaten the life of the pregnant woman or cause a lot of discomfort.

This is because the medication used for sedation can cause malformation in the fetus, especially in the first 3 months, when the formation of the neural tube occurs. It can also promote the termination of pregnancy.

I have diabetes, can I use insulin on the day of the exam?

You will probably have to adapt your insulin dosage on the day of the exam. In any case, it is important to inform the doctor about the situation, so that he can judge the need to adjust your dose and how it should be administered.

Can I drive back on the day of the exam?

No. As already mentioned above, the examination will only be performed with the presence of a companion, as the effects of anesthesia can leave the patient disoriented.

For the same reason, it is not recommended that the patient drive, as he may not have all his reflexes accurate enough.

It is also not recommended to operate machinery or other types of work.

Why don’t I remember taking the exam?

Amnesia in relation to the endoscopy exam is a very common effect, resulting from the use of sedation used during the procedure. The absence of remembrance on the part of the patient is an indication that the procedure was performed without pain or discomfort, so amnesia is desirable.

This memory loss should last for a maximum of one hour. Even if the patient wakes up right after the end of the procedure, which usually lasts 30 minutes, he will not remember the moment he will be under observation as the anesthesia effect wears off.


Have you taken the exam yet? If so, tell us in the comments how your experience was! And you who got here, because you wanted to research how the exam worked: were your doubts clarified? We hope so!

If this text was useful for you, share it with that friend who is nervous about having to do an endoscopy!

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