Upper Endoscopy: Diagnostic and Therapeutic

Abstract

Indications • Supplementary workup for upper GI complaints:-Dysphagia.-Odynophagia.-Gastroesophageal reflux disease.-Abnormal barium radiograph/CT scan.-Asses the degree of injury following caustic ingestion.-Investigation of iron deficiency anemia.-Unremitting epigastric pain.-Persistent vomiting. • Therapeutic measures:-Foreign body impaction-Gastrointestinal bleeding-Dilation of esophageal stricture (peptic stricture/postsurgical stricture/caustic stric-ture/malignant stricture)-Treatment of achalasia with pneumodila-tion/Botox injection or POEM (peroral esophageal myotomy)-Percutaneous insertion of gastrostomy or jejunostomy-Surveillance for neoplasia in patients with conditions predisposing to malignancy (such as Barrett's esophagus, gastric ulcer, gastric polyposis, pernicious anemia, intestinal metaplasia, previous gastrectomy, familial polyposis) Contraindication • Severe comorbidities and inability to tolerate conscious sedation • Recent gastrointestinal anastomoses (relative) Essential Steps 1. Position in the left lateral decubitus position. 2. Adequately anesthetize the oropharynx with lidocaine spray. 3. Adequate intravenous sedation and analgesia. 4. Place bite block. 5. Place endoscope in the oropharynx and advance it under direct endoscopic visualization. • Intubate the esophagus and advance into the stomach. • Biopsy the esophagus if abnormality noted. • Inspect Z-line and note its location from the incisors. • Biopsy Z-line if irregular or the presence of Barrett's metaplasia.