Gastroesophagoscopy - Hiatal Hernia and Barrett's Esophagus (Oesophagus)Video

Gastroesophagoscopy - Indications, Risks and Complications

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Gastroesophagoscopy (Upper GI Endoscopy) is one of the most common procedures performed in the United States. A fiber optic endoscope is passed through the mouth and used to evaluate a variety of ailments which involve the Upper Gastrointestinal Tract. The procedure is usually performed on an out-patient basis. A fiberoptic scope (see pictures on the left) can be inserted through the mouth. The patient undergoes heavy sedation and the procedure is often performed at a surgery center. A newer alternative procedure is Transnasal Gastroesophagoscopy (Esophagoscopy or Oesophagoscopy). This procedure uses a smaller scope which is inserted trough the nose. This procedure is often performed in the office with topical local anesthesia. Sedation is not usually required.

Indications for the procedure may include:

#1. Gastroesophageal reflux (GERD) -- Learn More
#2. Stomach Ulcers
#3. Abdominal Pain
#4. Bleeding From the GI Tract
#5. Dysphasia or difficulty eating. This may be caused by cancers, scaring or strictures or neuromuscular disorders.
#6. Suspected cancer. Patients who drink and smoke are at a higher risk of developing esophageal cancer.

Complications Include:

#1. Reactions to anesthetic agents.
#2. Bleeding
#3. Perforation of the GI tract - This can cause a severe life threatening infection of mediastinitis (infection of the chest) or peritonitis (infection of the abdominal cavity).
If you undergo a gastroesophagoscopy and experience bleeding, chest or abdominal pain, vomiting or fever after the operation you should seek medical attention immediately.

Procedure #1: Gastroesophagoscopy demonstrating a large hiatal hernia, a Schatzki's Ring and mild gastritis.

A hiatal hernia is composed of the upper portion of the stomach which has entered into the chest. The diaphragm constricts the stomach as it enters the chest. This forms a pouch between the top of the stomach (lower esophageal sphincter) and the diaphragm. Most patients have no symptoms but some experience symptoms of heart burn.

A Schatzki's Ring is a thin ring in the lower esophagus. They are often asymptomatic and need no treatment. However if tight, symptoms of food sticking in the chest when swallowing may occur. Rarely obstruction of the esophagus. Symptomatic cases may require dilatation.

Gastritis is inflammation of the stomach. This can be caused by too much stomach acid or an infection with Helicobacter pylori.

Procedure #2: Gastro-esophagoscopy in a patient with Barrett's Esophagus, small hiatal hernia, and gastritis.

Barrett's Esophagus is a condition where the stomach's mucosa grows into the lower esophagus. It is caused from chronic gastroesophageal reflux disease or GERD. It is a rare condition, occurring in less than 1% of patients with reflux. Patients with Barrett's esophagus have a greater risk of developing esophageal cancer. Endoscopy and biopsy is required at an interval of at least every one to three years. More frequent intervals may be required if the biopsies show dysplastic or abnormal mucosa. Treatment of Barrett's Esophagus is aimed at careful observation and controlling the gastroesophageal reflux disease. Proton pump inhibitors such as omeprazole (Prilosec) or surgery may recommended. Surgery may be aimed at controlling the reflux disease with a Nissen fundo plication or endoscopically resecting the esophageal mucosa. Learn More About Reflux Disease

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