upper gastrointestinal endoscopy

• 上部消化管内視鏡検査

関

upper endoscopy

WordNet

1. the topmost one of two
2. piece of leather or synthetic material that forms the part of a shoe or boot above the sole that encases the foot; "Uppers come in many styles"
3. higher in place or position; "the upper bunk"; "in the upper center of the picture"; "the upper stories"
4. superior in rank or accomplishment; "the upper half of the class"
5. of or relating to the stomach and intestines; "a gastrointestinal disorder" (同)GI
6. visual examination of the interior of a hollow body organ by use of an endoscope

PrepTutorEJDIC

1. (場所・位置が)『上のほうの』,上部の / 『上級の』,上位の / 奥地の,上流の / 靴の甲皮(こうがわ)(かかとより上の部分) / 覚醒剤（これの反意語はdowner：鎮静剤）
2. 胃腸の,胃腸に影響する

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/10/23 06:00:00」(JST)

wiki en

[Wiki en表示]

Esophagogastroduodenoscopy
Intervention
Endoscopic still of esophageal ulcers seen after banding of esophageal varices, at time of esophagogastroduodenosocopy
ICD-9-CM	45.13
MeSH	D016145
OPS-301 code:	1-631, 1-632

In medicine (gastroenterology), esophagogastroduodenoscopy or panendoscopy is a diagnostic endoscopic procedure that visualizes the upper part of the gastrointestinal tract up to the duodenum. It is considered a minimally invasive procedure since it does not require an incision into one of the major body cavities and does not require any significant recovery after the procedure (unless sedation or anesthesia has been used). However, a sore throat is common.

Alternative names

Esophagogastroduodenoscopy may be abbreviated to 'EGD' while panendoscopy is to 'PES'. It is also called 'upper GI endoscopy', 'gastroscopy' or simply 'endoscopy' (since it is the most commonly performed type of endoscopy, the ambiguous term 'endoscopy' refers to EGD by default).

Indications

Diagnostic

• Unexplained anemia (usually along with a colonoscopy)
• Upper gastrointestinal bleeding as evidenced by hematemesis or melena
• Persistent dyspepsia in patients over the age of 45 years
• Heartburn and chronic acid reflux - this can lead to a precancerous lesion called Barrett's esophagus
• Persistent vomiting
• Dysphagia - difficulty in swallowing
• Odynophagia - painful swallowing
• Persistent nausea

Surveillance

• Surveillance of Barrett's esophagus
• Surveillance of gastric ulcer or duodenal ulcer
• Occasionally after gastric surgery

Confirmation of diagnosis/biopsy

• Abnormal barium swallow or barium meal
• Confirmation of celiac disease (via biopsy)

Therapeutic

• Treatment (banding/sclerotherapy) of esophageal varices
• Injection therapy (e.g. epinephrine in bleeding lesions)
• Cutting off of larger pieces of tissue with a snare device (e.g. polyps, endoscopic mucosal resection)
• Application of cautery to tissues
• Removal of foreign bodies (e.g. food) that have been ingested
• Tamponade of bleeding esophageal varices with a balloon
• Application of photodynamic therapy for treatment of esophageal malignancies
• Endoscopic drainage of pancreatic pseudocyst
• Tightening the lower esophageal sphincter
• Dilating or stenting of stenosis or achalasia
• Percutaneous endoscopic gastrostomy (feeding tube placement)
• Endoscopic retrograde cholangiopancreatography (ERCP) combines EGD with fluoroscopy
• Endoscopic ultrasound (EUS) combines EGD with 5–12 MHz ultrasound imaging

Newer interventions

• Endoscopic trans-gastric laparoscopy
• Placement of gastric balloons in bariatric surgery

Equipment

• Endoscope
  • Non-coaxial optic fiber system to carry light to the tip of the endoscope
  • A chip camera at the tip of the endoscope - this has now replaced the coaxial optic fibers of older scopes that were prone to damage and consequent loss of picture quality
  • Irrigation channel to clean the lens
  • Suction/Insufflation/Working channels - these may be in the form of one or more channels
  • Control handle - this houses the controls
• Stack
  • Light source
  • Insufflator
  • Suction
  • Electrosurgical unit
  • Video recorder/photo printer
• Instruments
  • Biopsy forceps
  • Snares
  • Injecting needles
• Chemical agents
  • Dimethicone
  • Acetate
  • Indigo carmine

Procedure

The patient is kept NPO (Nil per os) or NBM (Nothing By Mouth) that is, told not to eat, for at least 4 hours before the procedure. Most patients tolerate the procedure with only topical anesthesia of the oropharynx using lidocaine spray. However, some patients may need sedation and the very anxious/agitated patient may even need a general anesthetic. Informed consent is obtained before the procedure. The main risks are bleeding and perforation. The risk is increased when a biopsy or other intervention is performed.

The patient lies on his/her left side with the head resting comfortably on a pillow. A mouth-guard is placed between the teeth to prevent the patient from biting on the endoscope. The endoscope is then passed over the tongue and into the oropharynx. This is the most uncomfortable stage for the patient. Quick and gentle manipulation under vision guides the endoscope into the esophagus. The endoscope is gradually advanced down the esophagus making note of any pathology. Excessive insufflation of the stomach is avoided at this stage. The endoscope is quickly passed through the stomach and through the pylorus to examine the first and second parts of the duodenum. Once this has been completed, the endoscope is withdrawn into the stomach and a more thorough examination is performed including a J-maneuver. This involves retroflexing the tip of the scope so it resembles a 'J' shape in order to examine the fundus and gastroesophageal junction. Any additional procedures are performed at this stage. The air in the stomach is aspirated before removing the endoscope. Still photographs can be made during the procedure and later shown to the patient to help explain any findings.

In its most basic use, the endoscope is used to inspect the internal anatomy of the digestive tract. Often inspection alone is sufficient, but biopsy is a very valuable adjunct to endoscopy. Small biopsies can be made with a pincer (biopsy forceps) which is passed through the scope and allows sampling of 1 to 3 mm pieces of tissue under direct vision. The intestinal mucosa heals quickly from such biopsies.

Biopsy allows the pathologist to render an opinion on later histologic examination of the biopsy tissue with light microscopy and/or immunohistochemistry. Biopsied material can also be tested on urease to identify Helicobacter pylori.

Complications

The complication rate is about 1 in 1000. They include:

• aspiration, causing aspiration pneumonia
• bleeding
• perforation
• cardiopulmonary problems

Limitations

Problems of gastrointestinal function are usually not well diagnosed by endoscopy since motion or secretion of the gastrointestinal tract are not easily inspected by EGD. Nonetheless, findings such as excess fluid or poor motion of gut during endoscopy can be suggestive of disorders of function. Irritable bowel syndrome and functional dyspepsia is not diagnosed with EGD, but EGD may be helpful in excluding other diseases that mimic these common disorders.

Additional images

• Endoscopic image of adenocarcinoma of duodenum seen in the post-bulbar duodenum.

• Endoscopic image of gastric antral vascular ectasia seen as a radial pattern around the pylorus before (top) and after (bottom) treatment with argon plasma coagulation

• Endoscopic image of Barrett's esophagus, which is the area of red mucosa projecting like a tongue.

• Deep gastric ulcer

• Endoscopic still of duodenum of patient with celiac disease showing scalloping of folds.

• Gastric ulcer in antrum of stomach with overlying clot due to gastric lymphoma.

• Endoscopic image of a posterior wall duodenal ulcer with a clean base, which is a common cause of upper GI hemorrhage.

• Endoscopic images of an early stage stomach cancer. 0-IIa, tub1. Left column: Normal light. Right column: computed image enhanced(FICE). First row: Normal. Second row: Acetate stained. Third row: Acetate-indigocarmine mixture(AIM) stained.

See also

• Colonscopy

References

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

• 1. 上部消化管内視鏡検査（食道胃十二指腸内視鏡検査）の概要 overview of upper gastrointestinal endoscopy esophagogastroduodenoscopy
• 2. 成人における急性上部消化管出血へのアプローチ approach to acute upper gastrointestinal bleeding in adults
• 3. 消化不良成人患者へのアプローチ approach to the adult with dyspepsia
• 4. 成人における難治性胃食道逆流症へのアプローチ approach to refractory gastroesophageal reflux disease in adults
• 5. 内視鏡による食道狭窄拡張術の合併症 complications of endoscopic esophageal stricture dilation

English Journal

• Treatment of pyloric stenosis in a cat via pylorectomy and gastroduodenostomy (Billroth I procedure).

• Syrcle JA, Gambino JM, Kimberlin WW.SourceDepartment of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS 39762.
• Journal of the American Veterinary Medical Association.J Am Vet Med Assoc.2013 Mar 15;242(6):792-7. doi: 10.2460/javma.242.6.792.
• Case Description-A 5-month-old 1.9-kg (4.2-lb) spayed female Siamese cat was evaluated because of a history of decreased appetite, regurgitation, vomiting, and lack of weight gain. Clinical Findings-Radiographic findings included a fluid- and gas-distended stomach with a small accumulation of minera
• PMID 23445290

• NOTES in Europe: summary of the working group reports of the 2012 EURO-NOTES meeting.

• Meining A, Spaun G, Fernández-Esparrach G, Arezzo A, Wilhelm D, Martinek J, Spicak J, Feussner H, Fuchs KH, Hucl T, Meisner S, Neuhaus H.SourceMedical Department II, Technische Universität München, Munich, Germany.
• Endoscopy.Endoscopy.2013 Mar;45(3):214-7. doi: 10.1055/s-0032-1326205. Epub 2013 Feb 27.
• The sixth EURO-NOTES workshop (4 - 6 October 2012, Prague, Czech Republic) focused on enabling intensive scientific dialogue and interaction between surgeons, gastroenterologists, and engineers/industry representatives and discussion of the state of the practice and development of natural orifice tr
• PMID 23446668

• Functional heartburn: clinical characteristics and outcome.

• Surdea Blaga T, Dumitrascu D, Galmiche JP, Bruley des Varannes S.SourceaCIC-04 Inserm, Institut des Maladies de l'Appareil Digestif, CHU Nantes, France bUniversité de Nantes, Faculté de Médecine, Nantes, France cUniversity of Cluj, Cluj, Romania.
• European journal of gastroenterology & hepatology.Eur J Gastroenterol Hepatol.2013 Mar;25(3):282-90. doi: 10.1097/MEG.0b013e32835b108f.
• OBJECTIVES: Patients with heartburn and normal upper gastrointestinal endoscopy, normal oesophageal acid exposure, no symptom-reflux association and who fail to respond to a proton-pump inhibitor are classified as having functional heartburn (FH). This study aimed (i) to characterize the symptoms an
• PMID 23128061

Japanese Journal

• 食道原発悪性黒色腫の１切除例

• 前田 直見,白川 靖博,國府島 健,大原 利章,田邊 俊輔,野間 和広,櫻間 教文,藤原 俊義
• 岡山医学会雑誌 126(1), 45-48, 2014-04-01
• … He presented with dysphagia, and we performed an upper gastrointestinal endoscopy that detected a tumor in the thoracic part of the esophagus. … PET/CT, endoscopy and an esophagogram showed that a 70-mm scaled type 2+1 tumor in the thoracic esophagus and no metastases. …
• NAID 120005425655

• 内視鏡にて消褪経過を観察し得た特発性胃食道粘膜下血腫の1例

• 大江 晋司,渡邊 龍之,久米 惠一郎,柴田 道彦,日浦 政明,芳川 一郎,原田 大
• Journal of UOEH 36(2), 123-128, 2014
• 症例は74歳男性．吐血を主訴に当科入院となった．上部消化管内視鏡検査にて胃噴門部に暗赤色の巨大腫瘤を認め，腫瘤は上部食道へ連続していた．生検では血液成分を認めるのみで，悪性所見は指摘できなかった．ランソプラゾール30 mgの1日2回の静注投与開始後，5日間で腫瘤は潰瘍を形成した．以後はラベプラゾール10 mgの1日1回の経口投与へ変更し，2か月後に瘢痕化した．保存的加療のみにて腫瘤の消褪を認めたこ …
• NAID 130004640677

• Gastrointestinal Symptom Rating Scaleは上部消化管術後のQOLを評価できるか

• 本多 通孝,比企 直樹,布部 創也,清川 貴志,三浦 昭順,錦織 達人,草薙 洋,大西 良浩,脇田 貴文,福原 俊一
• 日本消化器外科学会雑誌 47(7), 365-373, 2014
• … 目的：上部消化管術後のQOLを測定する尺度としてGastrointestinal Symptom Rating Scale（以下，GSRSと略記）がしばしば用いられている．今回，術後患者の評価尺度としてのGSRSの妥当性を検証した．対象と方法：2012年6月から12月の期間，胃・食道術後患者を対象に横断的調査を行い，GSRSの各下位尺度得点（酸逆流，腹痛，消化不良，下痢，便秘）を評価した．併存的妥当性としてSF-12，known-groups妥当性として，術式，栄養学的 …
• NAID 130004561025

Related Links

• Upper GI Endoscopy

Upper gastrointestinal (GI) endoscopy is a procedure in which a doctor uses an instrument called an endoscope to see the lining of your upper GI tract. Doctors use upper GI endoscopy to find, and sometimes treat, problems in the ...

• Upper Gastrointestinal Endoscopy Test and Results

An upper gastrointestinal (UGI) endoscopy is a procedure that allows your doctor to look at the interior lining of your esophagus, your stomach, and the first part of your small intestine (duodenum) through a thin, flexible ...

Related Pictures

---

★リンクテーブル★

リンク元	「上部消化管内視鏡検査」
関連記事	「gastrointestinal」「upper」

「上部消化管内視鏡検査」

　　[★]

英

upper endoscopy、upper gastrointestinal endoscopy

関

上部内視鏡検査、胃ファイバースコープ

「gastrointestinal」

　　[★]

• adj.

• 胃腸の、胃腸管の、胃腸管系の
• 消化管の、消化器の、消化器系の

関

alimentary canal、alimentary system、alimentary tract、digestive organ、digestive system、digestive tract、gastrointestinal system、gastrointestinal tract、GI、GI tract、intestinal

　 　

「upper」

　　[★]

• adj.

• 上部の

関

upper part