Peptic Ulcers - Diagnosis

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Panendoscopy

Panendoscopy (also called gastroscopy or, simply, endoscopy) is a procedure that evaluates the esophagus, stomach, and duodenum using an endoscope (a long thin tube containing a tiny video camera). When used with biopsy, panendoscopy is the most accurate procedure for detecting the presence of peptic ulcers, bleeding, and stomach cancer. It can also be used to confirm a diagnosis of H. pylori.

Appropriate Candidates for Panendoscopy. Panendoscopy is invasive and expensive and not suitable for everyone with dyspepsia. Most individuals with these symptoms are managed effectively after simple screening methods.

Panendoscopy is usually reserved for patients with dyspepsia who also have risk factors for ulcers, stomach cancer, or both. Such factors include the following:

• Having so-called "alarm" symptoms (unexplained weight loss, gastrointestinal bleeding, vomiting, difficulty in swallowing, or anemia).
• Being over 45 (when the risk for stomach cancer increases).

There is some debate over whether patients under 45 with persistent dyspepsia and no alarm symptoms should have endoscopy.

The Procedure. Panendoscopy may be performed either in a hospital or in a doctor's office and typically involves the following.

• The doctor administers a local anesthetic using an oral spray and an intravenous sedative to suppress the gag reflex and to relax the patient.
• The doctor then places an endoscope (a thin, flexible plastic tube) into the patient's mouth and down the esophagus (food pipe) into the stomach.
• A tiny camera in the endoscope allows the doctor to see the surface of the esophagus, stomach, and duodenum and to search for abnormalities.
• The doctor will take about ten small tissue samples (biopsies), which will be used to test for H. pylori.