There are many upper gastrointestinal investigations. The commonest of these is diagnostic endoscopy. Modern endoscopes are only a little larger than a drinking straw and allow inspection of the whole of the oesophagus stomach and duodenum. The investigation is very accurate and is the main method of diagnosing stomach ulcers, duodenal ulcers,(see video of) assets/documents/Benign_stomach_ulcer.wmv Helicobacter pylori infection, gastric polyps, cancers of the stomach see video assets/documents/Stomach_Cancer.wmv and oesophagus and coeliac disease. Complications are extremely rare for simple diagnostic endoscopy. For full details of endoscopy go to.
Many therapeutic and diagnostic procedures can be performed at the same time as endoscopy. Barrett’s oesophagus can be diagnosed and examined in more detail under magnification or following the application of dyes to target specific areas for biopsy - see viedo assets/documents/Barretts_Oesophagus.wmv. Bleeding sources (e.g. bleeding arteries in the base of ulcers, vascular malformations and bleeding polyps) can all be treated by the application of metal clips. Oesophageal strictures can be dilated by solid dilators passed over stainless steel guide wires or by balloons. Metal stents can be placed through malignant strictures. Varicose veins of the oesophagus due to liver disease can be injected or banded.
X-rays taken while swallowing Barium have largely been superseded by endoscopy. This investigation still remains valuable in the diagnosis of swallowing disorders. Muscular disorders can also be examined with motility probes which allow an accurate record of muscle contraction. This can be associated with PH measurement to determine acid reflux into the oesophagus.
A special form of endoscopy called endoscopic retrograde cholangio pancreatography can be used to examine the pancreas and biliary tree. In this test a side viewing endoscope is inserted into the duodenum and access can be gained to the pancreatic and bile duct to diagnose stones, tumours and other abnormalities. A variety of therapeutic procedures including removal of stones and the insertion of stents can be performed. For further details on ERCP go to.
Endoscopic ultrasound allows for much for accurate assessment of structures in or close to the oesophagus, stomach, duodenum and pancreas because the probe situated on the end of the endoscope can be closely approximated to the area being examined. It is particularly useful in the assessment of tumours in the wall of the gut, a detection of bile duct stones and the assessment of pancreatic abscesses and tumours.