ABSTRACT
This chapter summarizes the indications, techniques, and uses of upper gastrointestinal endoscopy. It focuses on the esophagus and the gastro-esophageal junction (GEJ) and uses of flexible endoscopy directly relevant to esophageal surgeons. Modern standard endoscopes are designed to be placed transorally and have an approximate diameter of 10 mm with a 2.8 mm or greater working channel. Ultrathin endoscopes (less than 6 mm diameter) can be passed in the unsedated patient transnasally. There is some evidence they may be better tolerated in some patients. Most endoscopies are performed as outpatient procedures either with conscious sedation (usually achieved with a shortacting benzodiazepine) or local anesthetic throat spray. The "turn and suction" technique of endoscopic biopsies allows better acquisition of larger mucosal samples to aid in histological diagnosis. Management of patients who have had antireflux surgery and develop recurrent or new symptoms can be challenging. Together with contrast radiology and 24-hour pH studies, careful endoscopic assessment is valuable.
