When patients have had frequent or long-standing GERD symptoms, they can develop inflammatory changes to the esophagus called Barrett’s esophagus that can predispose them to esophageal cancer. The only way to make the diagnosis of Barrett’s is to do an endoscopy test. Difficulty swallowing can be evaluated and treated at the time of endoscopy.
An endoscopy test is usually done at a hospital or an ambulatory endoscopy center, which is a freestanding facility not associated with a hospital. An endoscope is a long, thin instrument that includes a light and a video camera that can be guided into narrow and small organs. Air and water can be passed into the endoscope and sucked out, allowing for cleaning retained material or mucus. Tools can be passed down the endoscope for tissue sampling, treatment of bleeding, and dilation of the esophagus. Tiny forceps can be used to take biopsies or long, thin balloons can be passed through the scope to dilate strictures. Video or still pictures can be taken with most endoscopes. Generally, a gastroenterologist performs endoscopy, but in some parts of the country general surgeons or other physicians perform them. The test evaluates the esophagus, stomach, and duodenum (the first part of the small intestine). During the exam, biopsies can be taken if needed.
If you are getting an endoscopy, you will be asked not to eat or drink anything after midnight the night before the test so your stomach will be empty. Your doctor may request you make minor changes in your medication; for example, you might hold off taking blood thinners such as clopidogrel (Plavix), warfarin (Coumadin), or aspirin for a few days prior to the examination. Also, diabetic patients must change their insulin dosing. Do not make any medication changes on your own—ask your doctor. Also, do not go to an endoscopy test alone. You will likely be sedated and given medication for relaxation or sleep and will not be able to drive after the test. Someone will need to drive you home.
Overall, from arrival to leaving is about 2 hours. A nurse or doctor will interview you, asking about your medical history, medications that you are taking, symptoms, and drug allergies. Your mouth, heart, lungs, and abdomen will be examined. An IV is placed so that the sedative medication can be given. Then, you will be brought into the procedure room. Monitors for oxygen levels, heart rhythm and rate, and blood pressure will be placed on your arms and chest. You will get supplemental oxygen because some people do not breathe as well while sedated. All of this occurs prior to starting the actual endoscopy test.
Once all of the preparation is complete, a nurse or anesthesiologist will administer the sedative. Patients may sleep through the exam and may not remember it, or they may be sleepy—it depends on the doctor and medications used for sedation. The mouth is usually sprayed or you will gargle with a topical anesthetic to numb the throat so the instrument can be easily passed. The topical anesthetic also helps to prevent you from gagging and is generally very effective even with patients who gag easily. Once sedated, an endoscope is passed into your mouth, down the esophagus, into the stomach and duodenum. The actual test takes only about 10 to 15 minutes. Endoscopy allows for direct visualization of the lining of the esophagus, and little pieces of tissue can painlessly be removed (biopsied) for analysis. If there is narrowing of the esophagus, it can be treated or dilated at this time.
After the exam patients are brought to a recovery room and will sleep off the sedative, which may take about 30 to 60 minutes. This is really the only “recovery” from the exam you need because no cuts or incisions are made and no pain results from the test. Most doctors recommend that you not drive, work, exercise, consume alcohol, or make important decisions the day of the exam because it takes about 24 hours for the medication to completely clear from your system. It is important that you avoid alcohol for 24 hours because it can interact with the medication that remains in your system.
By Mortin - Copyright 2009
Last modification 31/12/2009
What is an endoscopy?- References