Table of Contents
Upper Endoscopy
Upper endoscopy, also called esophagogastroduodenoscopy or panendoscopy, is more accurate than a barium swallow radiograph. It is also more invasive and expensive. It is widely used in GERD for identifying and grading severe esophagitis, monitoring patients with Barrett's esophagus, or when other complications of GERD are suspected. Upper endoscopy is also used as part of various surgical techniques.
Until recently, experts recommended screening with endoscopy for Barrett's esophagus and esophageal cancer at least once in a lifetime for patients with chronic GERD. However, new guidelines from the American Gastroenterological Association do not recommend endoscopy screening because there is no evidence that it can improve survival.
Endoscopy to Diagnose GERD. Endoscopy may be performed either in a hospital or doctor's office:
- The patient should eat nothing for at least 6 hours before the procedure.
- The doctor administers a local anesthetic using an oral spray and an intravenous sedative to suppress the gag reflex and relax the patient.
- Next, the physician places an endoscope (a thin, flexible fiberoptic tube containing a tiny camera) into the patient's mouth and down the esophagus. The procedure does not interfere with breathing. It may be slightly uncomfortable for some patients; others are able to sleep through it.
- Once the endoscope is in place, the camera allows the physician to see the surface of the esophagus and look for abnormalities, including hiatal hernia and damage to the mucus lining.
- The physician performs a biopsy (the removal and microscopic examination of small tissue sections). The biopsy may detect tissue injury from GERD. It may also be used to detect cancer or other conditions, such as yeast (Candida albicans) or viral infections (such as herpes simplex and cytomegalovirus). Such infections are more likely to occur in people with impaired immune systems.
Complications from the procedure are uncommon. If they occur, complications are usually mild and typically include minor bleeding from the biopsy site or irritation where medications were injected.
If a patient has moderate-to-severe GERD symptoms and the procedure reveals injury in the esophagus, usually no further tests are needed to confirm a diagnosis. The test is not foolproof, however. A visual view misses about half of all esophageal abnormalities.
Capsule Endoscopy. In this test, the patient swallows a small capsule containing a tiny camera. Then, a series of color pictures are transmitted to a recording device where they can be downloaded and interpreted by a doctor. The entire procedure takes 20 minutes. The capsule is naturally passed through the digestive system within 24 hours. A newer technique has a string attached to the capsule for retrieval. Capsule endoscopy may provide a more attractive and less invasive alternative to traditional endoscopy. However, while capsule endoscopy is useful as a screening device for diagnosing esophageal conditions such as GERD and Barrett's esophagus, traditional endoscopy is still required for obtaining tissue samples.
Monitoring for Barrett's Esophagus and Cancer
Review Date: 07/11/2010
Reviewed By: Reviewed by: Harvey Simon, MD, Editor-in-Chief, Associate Professor
of Medicine, Harvard Medical School; Physician, Massachusetts
General Hospital. Also reviewed by David Zieve, MD, MHA, Medical
Director, A.D.A.M., Inc.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org)
