Gastroesophagoscopy (Upper GI
Endoscopy) is a common procedure were a fiber optic endoscope is passed through
the mouth and used to evaluate a variety of ailments which involve the Upper
Gastrointestinal Tract. The procedure is usually performed on an
out-patient basis. A fiberoptic scope (see pictures on the left) can be inserted through the
mouth. The patient undergoes heavy sedation and the procedure is
often performed at a surgery center. A newer alternative procedure
is Transnasal Gastroesophagoscopy (Esophagoscopy or Oesophagoscopy).
This procedure uses a smaller scope which is inserted trough the nose.
This procedure is often performed in the office with topical local
anesthesia. Sedation is not usually required.
Indications for the procedure may include:
#1.
Gastroesophageal reflux
(GERD) --
Learn More #2. Stomach Ulcers #3. Abdominal Pain #4. Bleeding From the GI Tract #5. Dysphasia or difficulty eating. This may be caused by
cancers, scaring or strictures or neuromuscular disorders. #6. Suspected cancer. Patients who drink and smoke are at a higher
risk of developing esophageal cancer.
Complications Include:
#1. Reactions to anesthetic agents. #2. Bleeding #3. Perforation of the GI tract - This can cause a severe life threatening
infection of mediastinitis (infection of the chest) or peritonitis (infection of
the abdominal cavity).
If you undergo a gastroesophagoscopy and
experience bleeding, chest or abdominal pain, vomiting or fever after the operation you should
seek
medical attention immediately.
Procedure #1:
Gastroesophagoscopy demonstrating a large hiatal hernia, a Schatzki's Ring and mild gastritis.
A hiatal hernia is composed of the upper portion of the stomach which
has entered into the chest. The diaphragm constricts the stomach
as it enters the chest. This forms a pouch between the top of the
stomach (lower esophageal sphincter) and the diaphragm. Most
patients have no symptoms but some experience symptoms of heart burn.
A Schatzki's Ring is a thin ring in the lower esophagus. They are often
asymptomatic and need no treatment. However if tight, symptoms of
food sticking in the chest when swallowing may occur. Rarely
obstruction of the esophagus. Symptomatic cases may require
dilatation.
Gastritis is inflammation of the stomach. This can be caused by
too much stomach acid or an infection with Helicobacter pylori.
Procedure #2: Gastro-esophagoscopy in a patient with Barrett's
Esophagus,
small hiatal hernia, and gastritis.
Barrett's Esophagus is a condition
where the stomach's
mucosa
grows into the lower
esophagus.
It is caused from chronic
gastroesophageal reflux
disease or GERD. It is a rare condition, occurring in
less than 1% of patients with reflux. Patients with Barrett's
esophagus
have a greater risk of developing
esophageal cancer. Endoscopy and biopsy is required at an
interval of at least every one to three years. More frequent
intervals may be required if the biopsies show dysplastic or
abnormal
mucosa.
Treatment of Barrett's Esophagus is aimed at careful observation and
controlling the
gastroesophageal reflux
disease. Proton pump
inhibitors such as omeprazole (Prilosec) or surgery may recommended.
Surgery may be aimed at controlling the reflux disease with a Nissen
fundo plication or endoscopically resecting the esophageal mucosa.
Learn More About
Reflux Disease
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