Upper Endoscopy: What It Is and Why You May (or May Not) Need It
Acid reflux disease is the most common upper gastrointestinal disease in the United States. With increasing prevalence comes the need for testing to accurately diagnose the condition, determine its severity and rule out other complications such as esophagitis or Barrett’s esophagus. Currently, the premier test for acid reflux complications is an upper endoscopy.
What is an upper endoscopy?
An upper endoscopy is a procedure that allows your physician to visually examine the esophagus, stomach and part of the small intestine. During the procedure a scope with a small camera is inserted through the mouth and into the esophagus. The physician is then able to get a firsthand look at the upper digestive tract. Biopsies are sometimes preformed at the same time, as are certain other treatments.
The upper endoscopy procedure usually takes place in an outpatient surgery center or hospital, but in some circumstances can also be performed in your doctor’s office. If you have additional medical complications, however, consult with your doctor on whether or not the endoscopy should take place in a hospital setting.
The procedure can last anywhere from 20 to 60 minutes. Most patients are lightly sedated. In some instances, sedation may be used to put the patient to sleep. (For example, our daughter was put under during her endoscopy in order to prevent her from getting scared and moving at an inappropriate time.)
When is an upper endoscopy called for?
There are several reasons that your physician might decide that you need an upper endoscopy. For instance, your doctor might see a need to:
- Further examine upper GI symptoms such as nausea, vomiting, bleeding, pain, weight loss or issues with swallowing.
- Search for the cause of conditions like anemia or vitamin and mineral deficiencies.
- Diagnose diseases like GERD, ulcers, cancer, esophagitis, EoE, Celiac disease or precancerous conditions.
- Monitor changes in an existing condition like esophageal stricture or Barrett’s esophagus.
Are upper endoscopies over-prescribed?
With the increase of acid reflux the need for upper endoscopy has increased. However, the test is not indicated for uncomplicated heartburn symptoms. In the absence of additional indications (as mentioned above) the American College of Physicians (ACP) notes that the screening should not be used in women of any age, or in men below the age of 50 years old.
According to a 2012 review of the clinical guidelines for the use of upper endoscopy, studies demonstrate that 10 percent to 40 percent of upper endoscopies are not "generally indicated." At an average cost of $800 per scope, that's an awful lot of unnecessary expense.
The test, like any other procedure, also carries small risks. Some of the complications, although rare, include: aspiration pneumonia, respiratory failure, hypotension, dysrhythmia, reactions to the anesthetic agents, perforation of the esophagus, cardiovascular events, or even death in extremely rare instances. If the test isn’t needed to begin with, it certainly isn’t worth risking complications, no matter how small they might be.
What to discuss with your physician
If you have any questions about upper endoscopy, be sure to talk with your physician. Let her know before your appointment that you have additional questions so that she can allot enough time to answer them. Your doctor should be able to give you a good explanation of the test and why it is indicated in your specific case. If you feel your questions or concerns are being brushed off, or if you still don’t understand why you need the test, don’t be afraid to seek a second opinion.
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Jennifer has a bachelor's degree in dietetics as well as graduate work in public health and nutrition. She has worked with families dealing with digestive disease, asthma and food allergies for the past 12 years. Jennifer also serves the Board of Directors for Pediatric Adolescent Gastroesophageal Reflux Association (PAGER).