Not so very long ago, patients with excessive heartburn, unexplained abdominal pain or stomach ulcers inevitable had to undergo an "upper GI" that involved swallowing liquid barium sulfate to enhance visualization of the GI tract on X-rays. The "upper GI" was not only "hard to swallow," but resulted in a false negative a number of times.
With the advent of upper GI endoscopy, a procedure that boasts a much higher accuracy rate, more options now exist for these patients. "In determining which test to administer, I consider many factors," says Sam Rahbar, M.D., gastroenterologist at Century City Hospital. "If the patient is over 40, has significant associated symptoms including weight loss and loss of appetite, I may skip the upper GI and go directly to the endoscopy. This also holds true for women in their childbearing years, who should avoid excess exposure to radiation. We can save patients time and help eliminate unnecessary procedures."
Endoscopy offers a wide spectrum of diagnostic and therapeutic interventions for the upper GI tract. Through miniature scopes, gastroenterologists can examine the pharynx, esophagus, complete stomach, duodenum, pancreas and bil duct system. "Endoscopy is particularly ideal for problems relating to the esophagus," Dr. Rahbar says. "For example, patients who have difficulty with swallowing and/or clearing secretions from the mouth, or trouble with inflammation, may have esophageal problems that can be detected through the endoscope. Endoscopy can then be used to stretch a narrowed esophagus, remove a tumor so the patient can swallow better, or stop bleeding."
Indeed, endoscopy is commonly used to treat bleeding ulcers. The physician can seal the bleeding area, thus eliminating the need for blood transfusions or surgery.
"We use the endoscope to biopsy and take out growths in the stomach that could turn into cancer," he says. "It is also helpful in removing a swallowed foreign body from the GI tract--for example, a piece of meat of bone stuck in the esophagus."
Dr. Rahbar notes that endoscopy has played an increasingly vital role in the examination and treatment of pancreas and bile duct problems, particularly in patients with evidence of infection in the bile duct system, or pancreatitis. "When a bile duct stone is stuck," he explains, "there are methods of removing it to prevent a life-threatening condition."
For certain obstructing pancreatic and bile duct cancers, tubes are placed through the tumor to maintain the openness of the tract, allowing the secretions and bile to drain into the intestine without accumulating in the liver.
Most upper GI endoscopic procedures take 15 to 45 minutes and are done on an outpatient basis. "Some patients may be apprehensive about endoscopy, and we take the time to reassure them that it is a safe, comfortable procedure," Dr. Rahbar notes. "As technology continues to improve, I suspect endoscopy will provide even more treatment options in the upper GI tract."
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