Upper Endoscopy

Dr. Saikrupa, MBBS

Telemedicine department

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The finest and most established technique in the Gastrointestinal world is the wonder of an upper gastrointestinal endoscopy. This is a tool through which the entire upper gastric system can be viewed as both a diagnostic and therapeutic way of management.

History of endoscope

Though the first-ever gastroscopy was done in 1868 by Kussmaul, it went unrecognised due to visual issues. Only after 25 years did the first instrument using lenses and prisms was introduced by Hoffmann. Even then, difficulties were faced as our gut isn’t straight as a pole.

The semi-flexible gastroscope was developed by Hopkins in 1954. Over the years, technology evolved, so did the development and techniques of endoscopes. In 1969, electronic imaging was introduced, which received a wider audience.

With the possibility of newer innovations, the journey through technology for an endoscope has come to using a Video Capsule Endoscopy.  

Endoscopy uses  

• An attempt to visualise the digestive tract was what initiated the whole innovative instrument.
• Slowly over the years, the endoscope has been improvised to visualise the oral cavity. The curiosity to dive deeper has now been used to correct the wrong in our natural system.  
• It visualises the upper end of the digestive system – from the oesophagus and stomach to the duodenum, i.e., beginning of the small intestine.  
• The instrument helps in both diagnosing and therapeutic ways of management.
• Achalasia of cardio – where the scope passes beyond cricoid cartilage, and when the fluid is aspirated, the cardiac orifice is located with much difficulty.  
• Benign stricture – helps diagnose and dilates the stricture with an oesophagal bougie.
• Carcinoma of the oesophagus – Diagnostic and helpful in taking biopsy.  
• Reflux esophagitis
• Endoscopy helps investigate chronic symptoms such as nausea, vomiting, abdominal pain, dysphagia and upper gastrointestinal bleed.
• It helps diagnose anaemia, inflammatory conditions, cancers, etc.  
• The procedure helps stop bleeding vessels, widen stricture, clip off polyps or remove any foreign objects.   
• The world keeps moving at a fast pace, and to keep up with the human demands, the evolution of endoscope use has gone from Inpatient basis to doing most of the procedures in most parts of the world on an Outpatient basis.
• Endoscopy is used for inpatients (IP) in surgical procedures such as removal of the gall bladder and removal of small tumours from the digestive system.

Pre-procedural preparation

Based on the indication for the use of the endoscope, some may require to fast for around 12 hours, and the procedure takes about 1 hour to complete. Medical history and procedural history should be listed. Anesthesia is given by IV sedation – TIVA.  

Combinations of techniques  

• The upper endoscopy is also used as – Rhinoscopy, Bronchoscopy, and otoscopy- for the nose, lower respiratory tract and ear, respectively.
• The combined use of ultrasound with an endoscope gives a wider spectrum to enhance the understanding of the digestive system and visualise its faults more effectively.
• Modern technology uses narrow banding imaging, which is helpful in locating pre-cancerous conditions with ease.   
• Laparoscopic procedures are modified endoscopes used in many areas where it requires only a keyhole incision giving huge advantages such as less blood loss and quick recovery.  
• Fibre optic endoscopy is used alongside a barium meal to figure out from pyloric obstructions to gastric dyspepsia.
• Endoscopic Retrograde Cholangiopancreatography is used diagnostically and therapeutically to detect lesions of the common bile duct and pancreatic ducts. The main complications of the procedure are infections such as cholangitis, serum hepatitis and pancreatitis.  

Post-procedural care

• The patient may feel some discomfort for a few days.  
• It is best to take easy-to-swallow and easily digestible meals.  
• It is best to avoid alcohol consumption post-procedure.  
• Drink a lot of fluids to prevent bloating.
• To take proper medications in case of post-procedural nausea and vomiting.  

Risks of endoscopy

Endoscopy is a relatively safe procedure with minimal bleeding, which resolves on its own. Severe complications such as perforation are very rare.

Advancements in endoscopy

• Video capsule endoscopy – helps not only in reviewing but also gives a precise interpretation of the images.  
• Contraindications – capsule retention due to suspected intestinal obstruction, strictures and fistulas. Pregnancy is also a big contraindication as there is a lack of data.  
• Indications – Obscure Gastrointestinal (GI) bleeding, Crohn’s disease, Celiac disease and intestinal polyps.  
• The disadvantage of the procedure is that a proper way to take biopsies is still underway.

Conclusion

The procedure of endoscopy was introduced as a patient-friendly tool and still continues to be one. With advancements like device-assisted capsules, we can now view the nook and corner of the digestive system with ease.  

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