Upper Gastrointestinal Endoscopy : Esophagogastroduodenoscopy

Upper Gastrointestinal Endoscopy : Esophagogastroduodenoscopy

Upper Gastrointestinal Endoscopy, or Esophagogastroduodenoscopy (EGD), is a special technique used to examine the upper digestive tract, including the esophagus, stomach, and the beginning part of the small intestine. This procedure utilizes a long, thin and flexible tube-like camera that is inserted through the mouth, which has a small rubber hose attached to it, with a lens and a bright light at its tip. The camera's image is displayed on a television screen, providing a clear and detailed image that is much more accurate than an X-ray. The results of the examination can be obtained immediately after the procedure.

The camera enables doctors to view the lining of the stomach and check for inflammation, ulcers, and abnormal tissue growth. They can also take tissue samples for pathological examination to detect cancer cells and culture to detect bacterial infections. EGD can also be used as a treatment option to stop bleeding in the upper gastrointestinal tract.

Why is an upper gastrointestinal endoscopy necessary?

Doctors use an endoscope to investigate the causes of various diseases or symptoms, such as:

• Upper abdominal pain, tongue pain, and intermittent pain, especially if the pain has persisted for more than 1-2 weeks.
• Vomiting of unknown cause
• Difficulty swallowing, feeling of food being stuck in the throat
• Abdominal bloating, excessive flatulence, decreased appetite, or nausea and vomiting.
• Gastrointestinal bleeding: vomiting blood, dark or bloody stool, or pale blood, which may indicate bleeding in the gastrointestinal tract, even if there is no accompanying abdominal pain.

What should you do to prepare before the examination?

1. Do not eat or drink anything for at least 6-8 hours before the examination to ensure that your stomach is empty, which makes it easier to see clearly and prevents the danger of food or water entering the airway while the endoscope is being inserted into the throat.
2. For patients with removable dentures or loose teeth, they must be removed or reported to the doctor to prevent them from falling out and obstructing the airway.
3. Patients are advised not to wear any jewelry.
4. It is recommended to have a relative or friend accompany you, especially if the doctor considers administering a sedative after the examination, as it is not advisable to drive yourself.
5. If you have any underlying medical conditions, it is important to inform your doctor. In some cases, the doctor may recommend stopping blood-thinning medications for 3-7 days before the examination.

What will happen to you during the examination?

1. When you arrive at the examination room, you will receive a throat spray that can be swallowed safely without any danger. This will make your throat feel numb temporarily, for about half an hour. Some patients may feel a tingling sensation in their throat at the beginning of the spray. If some patients feel anxious or nervous, the doctor may consider prescribing an anti-anxiety or pain-relieving medication.
2. During the endoscopic examination, you will need to lie on your left side. After the mouthguard is inserted, you will need to bite it to keep it in place while the endoscope is inserted through an opening in the guard.
3. After that, the doctor will perform the endoscopic examination by passing the scope through your mouth and down your throat to your esophagus. You will need to swallow the scope to guide it into your esophagus, and if there is saliva, it should be allowed to drain out. Do not swallow it, as it can cause choking. During the examination, it is recommended that you breathe deeply to relieve any discomfort or tightness in your abdomen. The examination will take approximately 10-15 minutes.

What should you do after the examination?

1. After anesthesia, patients may feel like there is phlegm or a thickness in their throat, which is a side effect of the anesthesia medication. This symptom will gradually disappear within 15-30 minutes after the medication wears off.
2. During the recovery period, patients should rinse their mouth with water but avoid drinking or eating too quickly to prevent choking.
3. After the anesthesia wears off, patients should start by drinking water to check if they can swallow normally before eating. Soft foods are recommended to make swallowing easier, and patients should avoid consuming very hot or cold foods.
4. Some patients who received a sedative injection to sleep may feel drowsy, and they should rest until they fully recover before being assessed by the medical staff. If the patient is safe and fully awake after about 90 minutes, they can undergo an evaluation and be transferred back to their room or discharged home.
5. Patients who are discharged home should follow the medication and dietary instructions provided by their doctor to ensure continuous and effective treatment. They should also attend all scheduled follow-up appointments for further evaluation and care.

Colonoscopy

Colonoscopy is a safe and effective method for evaluating problems in the large intestine. It involves using a small, slim, flexible tube with a video camera and a small light at the end to examine the large intestine. Once the camera is appropriately maneuvered and adjusted, the physician can move it in the desired direction. The images captured by the camera are displayed on a television monitor, providing high-quality clarity and enabling the physician to observe the details within the large intestine. This method is more accurate and precise than using an X-ray.

Colonoscopy should be performed on individuals with the following symptoms:

• • Abnormalities in bowel movements, such as constipation or diarrhea that occur regularly, or alternating constipation and diarrhea
  • Blood in the stool, which may be bright red or dark and foul-smelling
  • Protrusions of tissue and bleeding during bowel movements
  • Abdominal discomfort, bloating, and abdominal pain
  • Presence of a lump in the abdomen, weight loss, weakness, and fatigue
  • Individuals aged 50 and above should undergo colonoscopy every 3-5 years

What can be detected through colonoscopy:

• • Hemorrhoids
  • Inflammatory bowel disease
  • Polyps
  • Diverticula (small pouches that bulge outward through the colon wall)
  • Tumors or cancer of the colon

Preparing for a colonoscopy:

• • Three days before the exam, eat easily digestible food.
  • Avoid eating vegetables, fruits, and foods with fiber.
  • Take the prescribed laxatives as directed by the doctor.
  • The night before the exam, fast from food and drink until after the procedure.
  • Have a family member or friend accompany you to the exam (some patients may be given sedatives and may feel drowsy afterward).

During the exam, patients may feel the urge to defecate or experience abdominal discomfort because the doctor needs to inflate the colon with air to get a better view. To alleviate these symptoms, patients can practice the following:

• • Take slow and deep breaths.
  • Relax and avoid tensing up.
  • Do not move or wiggle during the exam.

Symptoms that may be encountered after the examination:

• • Abdominal discomfort and bloating may subside when the patient passes gas.
  • Pain in the lower abdomen or bladder, these symptoms may gradually subside and disappear.

Post-procedure instructions for colonoscopy:

• • Observe the stool for any small amount of blood. If there is abnormal bleeding, seek medical attention immediately.
  • Do not drive or operate machinery or engage in decision-making related work for at least 24 hours. This is because the sedative medication used during the procedure may still have residual effects and cause drowsiness.
  • If there are abnormal symptoms such as severe abdominal pain, abdominal distension, or high fever, seek medical attention immediately.
  • Follow up with the prescribed treatment and keep scheduled appointments.

References:

Mahidol University. Gastrointestinal Endoscopy Center. "Gastrointestinal endoscopy of the upper digestive tract and the first part of the small intestine." [Online]. Available: http://www.si.mahidol.ac.th/office_d/adm/Gi_scope/egd.html (September 7, 2017).

Bumrungrad Hospital. Digestive Disease & GI Center. "Upper gastrointestinal endoscopy." [Online]. Available: https://www.bumrungrad.com.th/digestive-diseases-gi-center-tretment-bangkok-thaoland/procedures/upper-gi-endoscopy#Benefits (September 7, 2017).

"Sigmoidoscopy and colonoscopy." [Online]. Available: http://siamhealth.net/public_html/investigation/gi/endoscope.htm#.WbiAS6gxWEd (September 7, 2017).