A sub-specialty of Internal medicine, gastroenterology deals with the diagnosis, treatment and management of components of the gastrointestinal tract. A gastroenterologist covers all concerns starting from the oesophagus to the rectum and treat illnesses such as Achalasia, Gastroparesis and Appendicitis.
Hepatology deals with all diseases of the liver and associated concerns. According to WHO, there is an influx of approximately 150,000 cases of Hepatitis each year in Pakistan. This is due to the poor sanitation and sewage conditions of Pakistan, which cause the persistence of the virus. The study of hepatology works to administer medical care which can combat the liver damage sustained due to hepatitis and other diseases such as cirrhosis, Liver cancer and polycystic liver disease.
Both branches of medicine require significant aftercare to ensure a good quality of life. Medical Practitioners aim to do so through the introduction of minimally invasive technology that can aid in the diagnosis of the concerned areas.
An upper endoscopy/Gastroscopy/EGD
An upper endoscopy is a procedure used to visually examine your upper digestive system with a tiny camera on the end of a long, flexible tube. A specialist in diseases of the digestive system (gastroenterologist) uses an endoscopy to diagnose and, sometimes, treat conditions that affect the esophagus, stomach and beginning of the small intestine (duodenum).
The medical term for an upper endoscopy is esophagogastroduodenoscopy. You may have an upper endoscopy done in your doctor’s office, an outpatient surgery center or a hospital.
Why it’s done
An upper endoscopy is used to diagnose and, sometimes, treat conditions that affect the upper part of your digestive system, including the esophagus, stomach and beginning of the small intestine (duodenum).
Your doctor may recommend an endoscopy procedure to:
- Investigate symptoms. An endoscopy may help your doctor determine what’s causing digestive signs and symptoms, such as nausea, vomiting, abdominal pain, difficulty swallowing and gastrointestinal bleeding.
- Diagnose. Your doctor may use an endoscopy to collect tissue samples (biopsy) to test for diseases and conditions, such as anemia, bleeding, inflammation, diarrhea or cancers of the digestive system.
- Treat. Your doctor can pass special tools through the endoscope to treat problems in your digestive system, such as burning a bleeding vessel to stop bleeding, widening a narrow esophagus, clipping off a polyp or removing a foreign object.
An endoscopy is sometimes combined with other procedures, such as an ultrasound. An ultrasound probe may be attached to the endoscope to create specialized images of the wall of your esophagus or stomach. An endoscopic ultrasound may also help your doctor create images of hard-to-reach organs, such as your pancreas. Newer endoscopes use high-definition video to provide clearer images.
Many endoscopes allow your doctor to use technology called narrow band imaging, which uses special light to help better detect precancerous conditions, such as Barrett’s esophagus.
An endoscopy is a very safe procedure. Rare complications include:
- Bleeding. Your risk of bleeding complications after an endoscopy is increased if the procedure involves removing a piece of tissue for testing (biopsy) or treating a digestive system problem. In rare cases, such bleeding may require a blood transfusion.
- Infection. Most endoscopies consist of an examination and biopsy, and risk of infection is low. The risk of infection increases when additional procedures are performed as part of your endoscopy. Most infections are minor and can be treated with antibiotics. Your doctor may give you preventive antibiotics before your procedure if you are at higher risk of infection.
- Tearing of the gastrointestinal tract. A tear in your esophagus or another part of your upper digestive tract may require hospitalization, and sometimes surgery to repair it. The risk of this complication is very low — it occurs in an estimated 1 of every 2,500 to 11,000 diagnostic upper endoscopies. The risk increases if additional procedures, such as dilation to widen your esophagus, are performed.
You can reduce your risk of complications by carefully following your doctor’s instructions for preparing for an endoscopy, such as fasting and stopping certain medications.
Signs and symptoms that could indicate a complication
Signs and symptoms to watch for after your endoscopy include:
- Chest Pain
- Shortness of breath
- Bloody, black or very dark colored stool
- Difficulty swallowing
- Severe or persistent abdominal pain
- Vomiting, especially if your vomit is bloody or looks like coffee grounds
Call your doctor immediately or go to an emergency room if you experience any of these signs or symptoms.
How you prepare
Your doctor will give you specific instructions to prepare for your endoscopy. In some cases your doctor may ask that you:
- Fast before the endoscopy. You will need to stop drinking and eating four to eight hours before your endoscopy to ensure your stomach is empty for the procedure.
- Stop taking certain medications. You will need to stop taking certain blood-thinning medications in the days before your endoscopy. Blood thinners may increase your risk of bleeding if certain procedures are performed during the endoscopy. If you have chronic conditions, such as diabetes, heart disease or high blood pressure, your doctor will give you specific instructions regarding your medications.
Tell your doctor about all the medications and supplements you’re taking before your endoscopy.
Plan ahead for your recovery
Most people undergoing an upper endoscopy will receive a sedative to relax them and make them more comfortable during the procedure. Plan ahead for your recovery while the sedative wears off. You may feel mentally alert, but your memory, reaction times and judgment may be impaired. Find someone to drive you home. You may also need to take the day off from work. Don’t make any important personal or financial decisions for 24 hours.
What you can expect
During an endoscopy
During an upper endoscopy procedure, you’ll be asked to lie down on a table on your back or on your side. As the procedure gets underway:
- Monitors often will be attached to your body. This will allow your health care team to monitor your breathing, blood pressure and heart rate.
- You may receive a sedative medication. This medication, given through a vein in your forearm, helps you relax during the endoscopy.
- Your doctor may spray an anesthetic in your mouth. This medication will numb your throat in preparation for insertion of the long, flexible tube (endoscope). You may be asked to wear a plastic mouth guard to hold your mouth open.
- Then the endoscope is inserted in your mouth. Your doctor may ask you to swallow as the scope passes down your throat. You may feel some pressure in your throat, but you shouldn’t feel pain.
You can’t talk after the endoscope passes down your throat, though you can make noises. The endoscope doesn’t interfere with your breathing.
As your doctor passes the endoscope down your esophagus:
- A tiny camera at the tip transmits images to a video monitor in the exam room. Your doctor watches this monitor to look for abnormalities in your upper digestive tract. If abnormalities are found in your digestive tract, your doctor may record images for later examination.
- Gentle air pressure may be fed into your esophagus to inflate your digestive tract. This allows the endoscope to move freely. And it allows your doctor to more easily examine the folds of your digestive tract. You may feel pressure or fullness from the added air.
- Your doctor will pass special surgical tools through the endoscope to collect a tissue sample or remove a polyp. Your doctor watches the video monitor to guide the tools.
When your doctor has finished the exam, the endoscope is slowly retracted through your mouth. An endoscopy typically takes 15 to 30 minutes, depending on your situation.
After the Endoscopy
You’ll be taken to a recovery area to sit or lie quietly after your endoscopy. You may stay for an hour or so. This allows your health care team to monitor you as the sedative begins to wear off.Once you’re at home, you may experience some mildly uncomfortable signs and symptoms after endoscopy, such as:
- Bloating and gas
- Sore Throat
These signs and symptoms will improve with time. If you’re concerned or quite uncomfortable, call your doctor.
Take it easy for the rest of the day after your endoscopy. After receiving a sedative, you may feel alert, but your reaction times are affected and judgment is delayed.
When you receive the results of your endoscopy will depend on your situation. If, for instance, your doctor performed the endoscopy to look for an ulcer, you may learn the findings right after your procedure. If he or she collected a tissue sample (biopsy), you may need to wait a few days to get results from the testing laboratory. Ask your doctor when you can expect the results of your endoscopy.
You may go back to your usual diet and activities after the procedure, unless your healthcare provider tells you otherwise.
Tell your healthcare provider if you have any of the following:
- Fever or chills
- Redness, swelling, or bleeding or other drainage from the IV site
- Abdominal pain, nausea, or vomiting
- Black, tarry, or bloody stools
- Trouble swallowing
- Throat or chest pain that worsens
Your healthcare provider may give you other instructions after the procedure, based on your situation.
Before you agree to the test or the procedure make sure you know:
- The name of the test or procedure
- The reason you are having the test or procedure
- What results to expect and what they mean
- The risks and benefits of the test or procedure
- What the possible side effects or complications are
- When and where you are to have the test or procedure
- Who will do the test or procedure and what that person’s qualifications are
- What would happen if you did not have the test or procedure
- Any alternative tests or procedures to think about
- When and how will you get the results
- Who to call after the test or procedure if you have questions or problems
- How much will you have to pay for the test or procedure