UPPER
GASTROINTESTINAL
ENDOSCOPY
Preceptor
Dr. Tommy Ruhimat, dr., SpB-KBD
Presented by :
Christopher Kusumajaya
Upper Gastrointestinal Endoscopy
Diagnostic Indications Therapeutic Indications
◦ Heartburn ◦ Control of bleeding
◦ Dysphagia or odynophagia ◦ Dilation of stricture
◦ Hematemesis or melena ◦ Removal of foreign bodies
◦ Dyspepsia or upper abdominal pain ◦ Removal of polyps
◦ Unexplained weight loss or anemia ◦ Tumor ablation
◦ Evaluation of abnormal Barium
meal X-ray
◦ Suspected malabsorption
Upper Gastrointestinal Endoscopy
Contraindications to Upper GI Endoscopy
◦ Uncooperative patient
◦ Hemodynamically unstable patient
◦ Suspected perforation
◦ cervical spine disorders
◦ Soon after a myocardial infarction
Upper Gastrointestinal Endoscopy
Patient preparation
◦ Fasted for at least 4 – 6 hours
◦ Before the study dentures & eye glasses should be removed.
◦ If intervention is anticipated, a recent coagulation profile
&platelet count should be within safe ranges.
◦ Prophylactic antibiotics indicated in
a. Sclerotherapy.
b. Previous endocarditis.
c. Recent vascular prosthesis.
d. For PEG tube placements.
e. Patients with prosthetic heart valves.
Method
Two squirts of lidocaine sprayed into the
pharynx or lidocaine viscus can be used.
Check List
◦ 24 hours before the examination
◦ Confirm indication
◦ Check contraindications
◦ Necessary lab tests ordered? (blood count,
coagulation)
◦ Antibiotic prophylaxis?
◦ Informed consent obtained?
◦ Patient instructed about fasting?
◦ Risk factors? (heart, lung, coagulation, general
health)
Immediately before the
examination
◦ Patient welcomed to the unit, greeted by name
◦ Signed consent form?
◦ Dentures removed?
◦ Coagulation tested?
◦ If necessary: peripheral venous access? (especially with
sedation and for interventions)
◦ Equipment check? (air, suction)
◦ Endoscope tip lubricated
◦ Pharyngeal anesthesia (if desired)
◦ Contact with patient: “Here we go.”
During the examination
◦ Talk to the patient, explain what is
happening.
◦ Keep the patient in a left lateral position.
◦ Observe the patient (sweating,
restlessness, facial expression, gestures,
pain manifestations, breathing, skin color).
◦ If in doubt: pulse oximetry,
echocardiogram (ECG) monitoring.
Inserting the Endoscope
◦ Blind Insertion
◦ Direct-Vision Insertion
◦ In the blind insertion method, the endoscope is
first passed over the base of the tongue toward
the hypopharynx under external visual control.
◦ With proper technique, the instrument tip can
be advanced just to the introitus of the upper
esophageal sphincter, at which time the patient
is instructed to swallow.
◦ Endoscope insertion is contraindicated while the
patient is coughing or taking a deep breath, as
this will inevitably lead to tracheal intubation
Upper Gastrointestinal Endoscopy
Normal Esophagus Normal Stomach Normal Duodenum
Esophagitis Gastric Ulcer Duodenal Ulcer
Gastric ulcer
Gastric ulcer Bleeding gastric ulcers
Esophageal Varices
Esophageal Varices Bleeding esophageal varices
Angiodysplasia of the stomach
Gastric Varices
Esophagitis
Diagnostic procedures
GI- Endoscopy
◦ Can remove polyps,
coagulate active
bleeding sites,
sclerotherapy of
esophageal varices,
dilate strictures &
obtain biopsy
samples
◦ Often guided by
ultrasound
Therapeutic
Endoscopy
Endoscopic treatment
◦ Upper Endoscopy is the procedure of choice
in majority of patients with an acute upper
gastrointestinal bleeding, for the following
reasons:
◦ It can define the source of bleeding in the majority of patients
with an upper gastrointestinal bleeding.
◦ It can stratify the patients risk of rebleeding.
◦ It can provide endoscopic therapy for esophageal and
gastric varices, peptic ulcer disease, Dieulafoy's lesion,
vascular malformations and tumors.
Therapeutic options
◦ For Non variceal bleeding
1. Injection therapy
2. Thermal energy
3. Endoscopic clipping
For Variceal bleeding
1. Sclerotherapy
2. Band ligation
Injection Therapy
◦ Materials
◦ Endoscope
◦ Suction pumps
◦ Water jet
◦ Single-lumen injection needles for
epinephrine and polidocanol,
◦ double-lumen needles for fibrin glue
◦ Epinephrine 1:10 000 in physiological
saline solution, 1%
◦ polidocanol, fibrin glue
◦ Duodenal ulcer (Clipping)
Argon plasma coagulation
◦ Esophageal Varices (Band ligation)
Band ligation of esophageal varices
Therapeutic options
◦ Percutaneous endoscopic Gastrostomy &
jejunostomy
for PEJ ; paediatric colonoscope with 160 cm flexible
scope is used.
◦ Foreign body extraction.
◦ Dilation of stricture
Instruments used for
foreign body removal
Therapeutic Endoscopy
Complications of Endoscopy
◦ Perforation, more in therapeutic endoscopy
◦ Aspiration
◦ Pancreatitis, cholangitis, perforation & bleeding after
ERCP.
