Upper Gastrointestinal (GI) Procedures

	Preparing for Upper Endoscopy
	Upper Endoscopy
	After Your Upper Endoscopy
	ERCP

Preparing for Upper Endoscopy
Prior to the procedure, you will be asked not to eat anything for 6 hours prior, or drink anything for 3 hours prior.  In addition, you may be asked to refrain from taking certain medications.

Once you arrive at our center, a nurse greets you, asks you to sign a consent form for entry into the ambulatory endoscopy center, and shows you where to change into a hospital gown.  

The nurse then brings you to a private endoscopy room and places nasal oxygen and several monitoring devices on your body. This equipment lets us monitor your heartbeat, blood pressure, and blood oxygen level during the endoscopy. You’re then hooked up to an intravenous (IV) line.  

Next, the doctor meets with you to answer any of your questions. Once you're ready, the doctor administers pain relievers and a sedative through the IV. The sedative brings you into a state called "conscious sedation." This is not like general anesthesia, where you’re unconscious, but a pleasant, sleepy, relaxed dreamlike state.

Once you have received your sedative, the doctor will insert an endoscope -- a thin, flexible, lighted tube -- into your mouth.  The scope is easily passed into your esophagus.  The tube is equipped with a tiny video camera that sends clear pictures to a TV monitor, letting the doctor see inside the upper gastrointestinal tract.

Upper Endoscopy
An upper Endoscopy (also known as esophagogastroduodenoscopy, or EGD) is an essentially painless and minimally invasive procedure that enables the gastroenterologist to examine the esophagus, stomach and upper small intestine. 

The upper endoscopy exam itself usually takes 15 to 20 minutes and can be used to diagnose and/or treat gastrointestinal conditions such as GERD, Barrett’s Esophagus, esophageal varices, esophagitis, swallowing difficulties, indigestion, ulcers and gastritis.

For the patient with symptoms of severe acid reflux (heartburn), the doctor may use upper endoscopy to diagnose GERD or diagnose Barrett’s Esophagus by taking a small sample of tissue for biopsy.   Having a biopsy is painless, because the lining of the esophagus has no pain receptor nerves.

One side effect of GERD is a difficulty in swallowing from a narrowing of the esophagus as a result of acid reflux.   In many cases, the gastroenterologist can alleviate it by inserting a balloon through the endoscope and inflating it to dilate the section of your esophagus that is constricted. 

Esophageal Manometry and Esophageal pH Monitoring are other tools used in the diagnosis and treatment of severe GERD.  These tests also may be used as informational tools in preparation for anti-reflux surgery. 

After Your Upper Endoscopy
After the exam, you’re taken to one of our state-of-the-art recovery rooms where you wake up. There your IV is removed, and you’re watched for a period of time. Most people feel OK after waking up.

As a last step, your doctor visits with you, describes how the exam went, and gives you instructions to follow upon returning home. Results of biopsies will be available to you in about 10 days.

The total time you’re at our center is 1-2 hours..  Because of the wooziness from sedation, you need someone to drive you home. In fact, you should avoid driving and going to work the rest of the day.

ERCP
ERCP (Endoscopic Retrograde Cholangiopancreatography) is a combination of endoscopy and x-rays, done at a hospital location.  ERCP allows the gastroenterologist to diagnose, and sometimes repair, conditions in the liver, gallbladder, bile ducts, and pancreas.  These conditions may include gallstones, scarring, leaks, and cancer. 

The liver is an organ that makes bile, which helps with digestion, and the gallbladder is a small, pear-shaped organ that stores bile until it is needed for digestion.  The bile ducts are tubes that carry bile from the liver to the gallbladder and small intestine.  The pancreas is a large gland that produces chemicals that help with digestion and hormones such as insulin. 

ERCP combines the use of x-rays and an endoscope.  Through the endoscope, the doctor can see inside the stomach and duodenum and inject dyes into the bile ducts and pancreas so that they can be seen on x-rays. 

Depending upon whether any conditions are found that need to be remedied, an ERCP can take from 30 to 90 minutes.  If the exam shows a gallstone or narrowing of the ducts, the gastroenterologist can insert instruments into the endoscope to remove or relieve the obstruction.  He can also take tissue samples for biopsy.