Outcome of patients underwent Upper Gastro lntestinal Endoscopy ( UGIE ) at surgical unit B , General Hospital Anuradhapura

lntroduction: UGIE (Upper Gastro lntestinal Endoscopy) is considered to be the gold standard for investigation of UGI pathology.'lt gives the opportunity for biopsy of lesions for histology in malignant disease, and histology, culture and urease test in Helicobacter pylori infection.' lt is the best type of investigation for upper gastrointestinal bleeding because of its better diagnostic value especially for superflcial lesions such as oesophagitis, gastritis, duodenitis. lt is free of exposure to ionizing radiation. The main limitations of the procedure are its invasiveness, discomfort, necessity of sedation at times and a slight risk of morbidity and even mortality.'These problems can be minimized by the introduction of bettei' equipment and good endoscopy practice.o The findings of the procedure is subjective since the endoscopist may be the only person who sees the Iesion. The introduction of closed circuit television (CCTV)with video and photographic recording, have helped to overcome the drawback of documentation of findings.


biopsy for histology.
Conclusion: There is a significant positive ccrrelation of the site of gastro oesophageal junction to the height of the patient.Awareness of this variation is valuable in stent selection, interpretation of Ba swallow, especially in cases were oesophageal obstruction prevent endoscopic examination is impossible.lntroduction: UGIE (Upper Gastro lntestinal Endoscopy) is considered to be the gold standard for investigation of UGI pathology.'ltgives the opportunity for biopsy of lesions for histology in malignant disease, and histology, culture and urease test in Helicobacter pylori infection.'lt is the best type of investigation for upper gastrointestinal bleeding because of its better diagnostic value especially for superflcial lesions such as oesophagitis, gastritis, duodenitis.lt is free of exposure to ionizing radiation.The main limitations of the procedure are its invasiveness, discomfort, necessity of sedation at times and a slight risk of morbidity and even mortality.'Theseproblems can be minimized by the introduction of bettei' equipment and good endoscopy practice.oThe findings of the procedure is subjective since the endoscopist may be the only person who sees the Iesion.The introduction of closed circuit television (CCTV)with video and photographic recording, have helped to overcome the drawback of documentation of findings.

Materials and methodology
Records of all UGIE performed betv"reen 26 March 2011and 31-August 2011-in the surgical unir B were analyzed.The endoscopic facilities were available as in-patients.Endoscopies were performed with the Olympus GIF Q145.Only forms of analgesia was throat spray with 2% lignocaine(1) .Biopsies were taken from lesions in the stomach and oesophagus for histology in suspicious cases.A total of 24 biopsies were taken in this group for histological analysis.When histology is inconclusive repeat endoscope were performed.lndications were malaena or haematemesis, epigastric pain or reflux, anaemia, dysphagia, unexplained vomiting, loss of weight or appetite and other elective procedures.
There were 16 (9%)gastric ulcers, 3 (1..5%) duodenal ulcers, 5(2.5%l doudenitis, 8 ( %)oesophageal varices, 3 (1.5%)upper gastric con gestion/bl eed i n g a nd LL(s.6%l h i atu s hern i a s, one duodenal polyp, one gastric small polyp, one gastric small haemangioma, 2 small oesophageal polyps, 2 laryngeal growths, one case with worms in duodenum. Heights of the patients were ranging from 135 cm - L76 cm.The distance to gastro oesophageal junction from incisor was ranging from 28 cm -47 cm.Scatter plot is illustrated in figure 3. duodenitis as well as carcinoma and helpful in therapeutic proced u res.'''Ou r study has shown that epigastric pain, dysphagia, anaemia and haematemeis or malaena were the commonest reasons for endoscopy (88%).Antral gastritis and peptic ulcers were the commonest cause of upper gastrointestinal bleeding in this group.Norma I end oscopy was re ported in 40% of the tota I number of patients endoscoped and in 18% of patients endoscoped for upper gastrointestinal bleeding.u In our study there was a steady fall in the normal endoscopy rate with advancing age, being as high as 73% in patients between the ages of 10 and 39 years, and as low as 30% in patients in patients between ages 40 to 69 years and t7% in ages between 70-89.
The normal endoscope rate of 40% in our study compares favourably with the 40% rale found in another study.'ln this same study a lower abnormal endoscopy rate was found in younger patients compared with older ones.
Our study also showed that malignant diseases of the oesophagus was more common in patients over fifty years of age, accounting for 11 out of 13 (77%) of all oesophageal carcinoma.ln patients belowthe age of thirty five, however, no oesophageal carcinoma cases diagnosed.All the stomach carcinoma patients were older than forty five years in this study.The low diagnostic finding in young people indicates that a thorough clinical need to be done before endoscope is requested.
UGIE is an expensive investigation because of high cost of the equipment and their maintenance.ln the third world countries therefore, care of the endoscope equipment is of extremely importance.
Our study has shown that there are many normal endoscopies particularly in young people under the age of 30 years.This age group also has a very low incidence of malignancies in the stomach or esophagus.So it is necessary to screen young patients carefully before referral for endoscope to reduce the cost and help to increase the life span of the endoscopes.Those with mild symptoms could be treated empirically for up to six weeks and lf symptoms do not resolve or recur d u ring this period then referrals can be made for endoscope.Patients, who present with upper gastrointestinal bleeding, anaemia, severe dyspeptic symptoms, and older patients, have their endoscopic examinatlon ea rly.u''Upper gastrointestinal endoscopy when done without sedation with pharyngeal anaesthesia alone is a safe and welltolerated procedure.'''''''o\y'y'edid not havethe facilitiesfor urease testto diagnose H. pylori infection.However no H.pylori were detected in any of the 24 biopsies done for histology.

Mean of
Figure 3 2SVradelis,, N Mavnard, B F Warren,S Keshav,S p L Travis Quality control in upper gastrointestinal endoscopy: detectlon rates of gastric cancer in Oxford 2005-2008.Postgrod Med J 2OLL.8't , first and second parts of duodenum were performed, ln ou r u nit we do not have facilities to do urease test.Age, sex, height, indication, distance from incisor teeth to gastro oesophageal junction, other findings and outcome were noted.ResultsThere were 1,01(56%) males and 81 '44%) females .Age range 16-85 years with a mean of 58.Flgure 1 indicates total number of patients underwent UGIE and number of cases with normal and abnormal fi nd i ngs. stomach Height patients was l-58.791 with a Standard deviation of Height of 8.37026.Mean of distance to gastro oesophageal junction from incisor teeth was 38.8235 cm with a Standard deviation of 2.58314.There is a significant positive correlation of the site of gatro oesophageal junction to the height of the patient.Awareness of this variation is valuable to the endoscopist in stent selection and insertion, interpretation of Ba swallow films, specially in cases were oesophageal obstruction prevent anymore endoscopic examination is impossible.'ConclusionUGIEcan be performed safely without sedation.There is a significant positive correlation of the site of gatro oesophageal junction to the height of the patient.Awareness of this variation is valuable in stent selectiorr, interpretation of Ba Outcome of patients underwent Upper Gastro lntestinal Endoscopy(UGIE)at surgical unit B, General HospitalAnuradhapura swalloW especially in cases were oesophageal obstruction prevent endoscopic examination is impossible.We found that the normal endoscopy rate is unduly high and needs to be reduced by References 1 Neenah S Abraham , Carlo A Fallone, Serge Mayrand , Jack Huang , Paul Wieczorek, Alan N Barkun Sedation versus No Sedation in the Authors careful screening of young patients in order to reduce the cost and to help prolong the lives of the end oscopes.