Understanding Upper Endoscopy

What is upper endoscopy or upper GI endoscopy, esophagogastroduodenoscopy (EGD)?

Upper endoscopy is a procedure that lets us examine the lining of the upper part of your gastrointestinal tract, which includes the esophagus, stomach and duodenum (first portion of the small intestine). We use a thin, flexible tube called an endoscope, which has its own lens and light source, and will view the images on a video monitor.

What happens during upper endoscopy?

We start by spraying your throat with a local anesthetic and by giving you a sedative to help you relax. You'll then lie on your side, and your doctor will pass the endoscope through your mouth and into the esophagus, stomach and duodenum. The endoscope doesn't interfere with your breathing, You will fall asleep during the procedure.

Why is upper endoscopy done?

Upper endoscopy helps us evaluate symptoms of persistent upper abdominal pain, nausea, vomiting or difficulty swallowing. It's the best test for finding the cause of bleeding from the upper gastrointestinal tract. It's also more accurate than X-ray films for detecting inflammation, ulcers and tumors of the esophagus, stomach and duodenum.

We might use upper endoscopy to obtain a biopsy (small tissue samples). A biopsy helps us distinguish between benign and malignant (cancerous) tissues. We also use a biopsy to test for Helicobacter pylori, the bacterium that causes ulcers.

Your doctor might also use upper endoscopy to perform a cytology test, where he or she will introduce a small brush to collect cells for analysis. Upper endoscopy is also used to treat conditions of the upper gastrointestinal tract. Your doctor can pass instruments through the endoscope to directly treat many abnormalities - this will cause you little or no discomfort. For example, your doctor might stretch (dilate) a narrowed area, remove polyps (usually benign growths) or treat bleeding.

What type of sedation is used for the endoscopic procedures?

We generally use TIVA (Total intravenous anesthesia - intravenous drugs Versed, Fentanyl, Propofol) to sedate patients that do not require airway intubation (placement of a breathing tube). In most cases, a Nurse anesthetist administers the drugs and monitors the patient closely during the procedure. The patient breathes on his own but is sedated enough not to have any discomfort, pain or recollection of the procedure.

In some cases MCS (Moderate Conscious Sedation - Fentanyl, Versed but no Propofol) is used that leads to a lesser degree of sedation but again the patient generally dol not experience pain or discomfort during the procedure.

With both forms of sedation, patients generally cannot recall what is said after the procedure and hence it is important for a family member to be present so that the doctor can explain the result of the procedure after it is completed.

Can I take my medications before the procedure?

Yes. Its okay to take your medications with sip of water at least 1 hour before the start of the procedure.

Will these procedures be covered by my insurance company?

We always check with your insurance and obtain an authorization if required before the procedure. Insurance companies generally cover most of the the cost. Most policies have a deductable and a co-pay and your part of the costs depend on your coverage. Generally, the deductible is 20%. Many policies cover Screening Colonoscopies at 100% with no deductable. If a polyp is removed during the procedure you might have to pay a part of the costs.

How much time does it take at the Endoscopy Center?

A total of 2-3 hours. We ask our patients to check in at the Bay Area Houston Endoscopy Center 1 hour before the scheduled time. During this period, a nurse would ask you questions regarding your health, place an IV line and dress you in a gown for the procedure. Average time for single procedure (EGD or colonoscopy) is 15-30 minutes, and when doing both of the procedures it can take up to 30-45 minutes. The patient spends about 30 minutes in recover. Soon after the procedures where Drs. Subramanyam and Malhotra would briefly talk to the family regarding the findings of the procedure. Please do not consider this to be a substitute for the follow up appointment in the office that you need to keep for getting the biopsy results and further management.

What preparations are required?

An empty stomach allows for the best and safest examination, so you should have nothing to eat or drink, including water, for approximately six hours before the examination. Your doctor will tell you when to start fasting as the timing can vary.

What happens during upper endoscopy?

We start by spraying your throat with a local anesthetic and by giving you a sedative to help you relax. You'll then lie on your side, and your doctor will pass the endoscope through your mouth and into the esophagus, stomach and duodenum. The endoscope doesn't interfere with your breathing, You will fall asleep during the procedure.

What are the possible complications of upper endoscopy?

Although complications can occur, they are rare when doctors who are specially trained and experienced in this procedure perform the test. Bleeding can occur at a biopsy site or where a polyp was removed, but it's usually minimal and rarely requires follow-up. Perforation (a hole or tear in the gastrointestinal tract lining) may require surgery but this is a very uncommon complication. Some patients might have a reaction to the sedatives or complications from heart or lung disease.

Although complications after upper endoscopy are very uncommon, it's important to recognize early signs of possible complications. Contact your doctor immediately if you have a fever after the test or if you notice trouble swallowing or increasing throat, chest or abdominal pain, or bleeding, including black stools. Note that bleeding can occur several days after the procedure.

If you have any concerns about a possible complication, please let us know during the clinic appointment or before the start of the procedure.

Main Office

Coastal Gastroenterology Associates

1015 Medical Center Blvd
Suite 1300
Webster, TX 77598

Phone: (281) 557-2527

Satellite Office 2

Coastal Gastroenterology Associates

7111 Medical Center Drive
2nd Floor 
Texas City, TX 77591

(by appointment only)

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