What is endoscopy of the esophagus, stomach, and duodenum?
Endoscopy of the esophagus, stomach and duodenum (upper endoscopy) is a way to examine your swallowing tube (esophagus), stomach, and first part of your small intestine (duodenum).

A narrow, flexible lighted tube is swallowed and advanced down your esophagus and into your stomach and small intestine. The lighted tube projects pictures to a monitor and allows the doctor to see the lining of your esophagus, stomach and intestine.

Why is it requested?
Your doctor may suggest this procedure if:

• There is a concern for cancer of the esophagus, stomach or duodenum
• To follow up cancer of the esophagus, stomach, or duodenum after treatment
• Another test (CAT scan, upper GI series) showed an abnormality
• You have difficulty swallowing
• You have stomach pain or ulcers
• You have persistent nausea and vomiting
• You have been bleeding from your stomach or intestine (vomiting blood or passing black tarry stool)
• You have bad heartburn

What information will it give my doctors?
This test will tell your doctors if there are any abnormalities in your esophagus, stomach or duodenum. If there are abnormalities such as tumors, growths or ulcers, biopsies (tissue samples) can be taken. Bleeding ulcers can also be treated with the tube.

What should my doctor know before I have this procedure done?
The doctor who performs the test will need to know your medical problems, the medications you take, and whether you are allergic to any medicines.

Where is this procedure done?
This procedure is done in the GI Endoscopy Suite (Duke Clinic 2H)

How do I prepare for this test?
This test needs to be done on an empty stomach. You should not eat anything after midnight the night before you are scheduled to have the test. If you are on blood thinners, your doctor may give you instructions to stop these several days before your test.

Do I need to have someone drive me home afterward?
Yes!! You need to bring a driver as you will be sedated (given medicine to make you sleepy) for the test.

What happens during the procedure?
The nurse will start an IV in your vein. You will lie on a stretcher and will be hooked up to a heart, blood pressure and breathing monitor. Your throat will then be sprayed with a numbing medicine so you don’t gag. You will be given medicine through your vein to make you sleepy. You will also have a small mouthguard placed between your teeth to protect them from the tube.

Once you are sleepy, the flexible lighted tube will be inserted into your mouth and gently passed into your esophagus. You may be asked to swallow to help the tube pass. Inspection of your esophagus, stomach and duodenum generally takes five to 10 minutes. Air is pumped into your stomach through the tube so the doctor can see. Therefore, you may feel bloated.

The test is not painful. There can be some minimal discomfort when first swallowing the tube. Biopsies (taking tissue samples through the tube) do not hurt as there are no nerves on the inside lining of your esophagus, stomach or duodenum.

If there is a narrowing in your esophagus due to cancer or scarring, this can be gently stretched to improve your swallowing. This can add time to the procedure, and there can be some minimal discomfort associated with stretching the esophagus.

During the procedure, you may hear the nurse ask you to swallow or to take deep breaths. You may also hear the doctor ask for the biopsy forceps (pinchers).

What happens after the procedure?
You will be taken to the recovery area where you will be monitored for about 30 minutes. Your family member or friend can sit with you. Once the sedation has worn off, you are allowed to go home. You can eat normally afterward, and resume regular activity the following day.

What are the risks associated with this procedure?

• There is a very small risk of bleeding or infection
• There is a risk of reaction to the medication
• There is a risk of aspiration or swallowing secretions into your breathing tube
• There is a risk of perforation (putting an accidental hole in your esophagus, stomach or duodenum that requires surgery to fix). This is fortunately the rarest complication (risk is less than 1 in 1000 for a standard exam). The risk is slightly higher if your esophagus needs to be stretched (risk is estimated between 3 and 10 in 1000).

You should ask your doctor how these risks apply to you.

When should I call the doctor?
Call the doctor immediately if:

• You develop severe chest or abdominal pain
• You develop a fever
• You have nausea or vomiting
• You have shortness of breath

How will I get the results of this test?
Your doctor can give you his/her impression immediately after the test. If biopsies were done, you will receive a call or letter from the doctor’s office. Additionally, you can call for the results (it generally takes two to three days before the results are in).

This article is intended as a resource for patients receiving their cancer care at Duke University Hospital or Duke Clinic. It is not intended to substitute for medical advice from your health care team. If your doctor’s instructions differ from the information in this article, please talk with your doctor before making any changes.

Source: Duke Cancer Patient Education Program / Patient & Family Education Committee 8/00