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Introduction ⬇

An upper endoscopy is an endoscopic examination of the upper gastrointestinal (UGI) tract (mouth to upper jejunum) and may be ordered as an esophagogastroduodenoscopy, panendoscopy, esophagoscopy, gastroscopy, duodenoscopy, or esophagogastroscopy.

An upper endoscopy allows direct visualization of the interior lumen of the esophagus, stomach, and duodenum with an endoscope and is indicated for patients with dysphagia; reflux symptoms; weight loss; hematemesis; melena; persistent nausea and vomiting; persistent epigastric, abdominal, or chest pain; and persistent anemia. It can confirm suspicious x-ray findings and establish a diagnosis in symptomatic patients with negative x-ray reports. An upper endoscopy can be used to diagnose and treat many abnormalities of the UGI tract, including hernias, gastroesophageal reflux disease, esophagitis, gastritis, strictures, varices, ulcers, polyps, and tumors. It can be used to remove swallowed foreign objects (e.g., a swallowed coin in a small child) and for placement of a percutaneous gastric or duodenal feeding tube. For patients who require some form of UGI surgery, it provides a safe way to perform presurgical screening and postsurgical surveillance.

Procedure ⬆ ⬇

  1. Remember that this examination is usually performed in an outpatient setting of a hospital or ambulatory clinic. It also may be performed in the operating room or in a critical care setting.

  2. Use a topical spray to anesthetize the patient’s throat.

  3. Start an IV line and use for administration of sedation alone or in combination with analgesic agents to achieve a state of conscious sedation. Resuscitation equipment must be available.

  4. Perform continuous monitoring of the patient’s vital signs, cardiac rhythm, and oxygen saturation (pulse oximetry).

  5. Remove partial dental plates or dentures. Insert a mouthpiece to prevent the patient from biting the endoscope and to prevent injury to the patient’s teeth, tongue, or other oral structures.

  6. Lubricate the endoscope well. Gently insert through the mouthpiece into the esophagus and advance slowly into the stomach and duodenum. Insufflate air through the scope to distend the area being examined so that optimal visualization of the mucosa is possible. Obtain tissue biopsy specimens and brushings for cytology. Take photos to provide a permanent record of observations.

  7. Inform the patient that they may have an initial gagging sensation that quickly subsides. During the procedure, the patient may belch frequently. Sensations of abdominal pressure or bloating are normal, but the patient should not experience actual pain.

  8. Immediately after the examination is completed, ask the patient to remain on the left side until fully awake.

Clinical Implications ⬆ ⬇

Abnormal results may indicate the following conditions:

  1. Hemorrhagic areas or erosion of an artery or vein

  2. Hiatal hernia

  3. Esophagitis, gastritis, duodenitis

  4. Neoplastic tissue

  5. Gastric ulcers (benign or malignant)

  6. Esophageal or gastric varices

  7. Esophageal, pyloric, or duodenal strictures

Interventions ⬆ ⬇

Pretest Patient Care

  1. Explain the purpose and procedure of the examination, the sensations that may be experienced, and the benefits and risks of the test. Refer to IV conscious sedation precautions in Chapter 1. Reassure the patient that the endoscope is thinner than most food swallowed. Inform the patient that they will be given sedation and may not recall much or any of the experience. Record preprocedure signs and symptoms (e.g., vomiting, melena [black, tarry feces], dysphagia, and persistent UGI pain).

  2. Ensure that the patient has fasted for 6–8 hours before the examination. Children may have clear liquids up until 2 hours before the procedure; however, each patient should be assessed on an individual basis, according to age, size, and general health status. Inpatients may have IV fluids to prevent dehydration.

  3. Confirm an informed signed consent is in the patient’s medical record before the procedure.

  4. Tell the patient that they should not experience discomfort or side effects after the sedative has worn off, but that they may have a slightly sore throat.

  5. Encourage the patient to urinate and defecate if possible before the examination.

  6. Follow guidelines in Chapter 1 for safe, effective, informed pretest care.

Posttest Patient Care

  1. Withhold food or liquids until the patient’s gag reflex returns.

  2. Monitor cardiac rhythm, blood pressure, pulse, respirations, and oxygen saturation according to the hospital or clinic policy, usually every 15–30 minutes, until the patient is fully awake.

  3. Ask the patient to lie on the left side until fully awake to help prevent aspiration.

  4. Encourage the patient to belch or expel air inserted into the stomach during the examination.

  5. Review test results; report and record findings. Modify the nursing care plan as needed.

  6. Follow guidelines in Chapter 1 for safe, effective, informed posttest care.

Clinical Alert

Complications are rare; however, the following complications can occur:

  1. Perforation

  2. Bleeding or hemorrhage

  3. Aspiration

  4. Infection

  5. Complications from drug reaction (leading to hypotension, respiratory depression or arrest, allergic or anaphylactic response)

  6. Complications from unrelated diseases (e.g., myocardial infarction, stroke)

  7. Death (very rare)

Reference Values ⬆

Normal