Upper Gastrointestinal Endoscopy Overview

Upper Gastrointestinal Endoscopy

• Aim: The aim of upper gastrointestinal endoscopy is to put patients' minds at ease, aid surveillance, identify diseases early, and allow for treatment.

Basics

• Patient Preparation: Patients typically fast before the procedure and a medical history of comorbidities is documented.
• Anesthesia: Endoscopy can be performed with various levels of anesthesia, including awake patients with good throat or nasal anesthesia (trans-nasal), or sedation with medication like midazolam or propofol.
• Monitoring: Oxygen, pulse oximetry, and blood pressure are monitored during the procedure.

Intubation

• Visual Guidance: Intubation is performed under direct vision.
• Airway Examination: The procedure involves examining the pharynx, upper airways, epiglottis, and cricopharyngeus muscle.
• Avoidance: The valleculae should be avoided during the procedure.

Oesophagus

• Mucosal Features: The mucosa is typically pearly white with visible, vascular markings and possible glycogen granules.
• Indentations: Indentations from surrounding structures like the left bronchus and left atrium may be present.
• Junction: The squamo-columnar junction (Z-line), and the oesophagic-gastric junction (OJG or TGF) are key anatomical regions.

Abnormalities

• Structural Problems: Webs, diverticula, strictures (including achalasia), inflammation, Barrett's, ulcers, and tumours are potential abnormalities.
• Vascular Conditions: Varices and vascular lesions, such as Dieulafoy lesions, are also relevant.
• Other Concerns: Food boluses and foreign bodies might be discovered.

Stomach

• Common Issues: Hiatal hernia, varices, gastritis, ulcers, and tumours are observed in the stomach's lining.
• Vascular Lesions: Vascular lesions, like Dieulafoy lesions, are of concern.

Neoplastic Diagnosis

• Diagnostic Techniques: Scope features (using methods like AF, NBI, FICE, iScan), dyes (like methylene blue, Lugol's, and acetic acid), submucosal injection, magnification, and confocal endoscopy can be utilized.
• Biopsy: An optical biopsy and EUS are important procedures.

Neoplastic Therapy

• Treatment: Procedures like dilatation, EMR (Endoscopic mucosal resection), ESD (Endoscopic submucosal dissection), stenting, and ablation are available treatment options.