What to Expect From an Endoscopy for Celiac Disease

The diagnosis of celiac disease usually involves blood tests and then an endoscopy, which is a medical procedure that allows your healthcare provider to look directly at your small intestine and take small samples to examine further under a microscope.

If your celiac disease blood tests came back positive, your healthcare provider very likely will recommend you have an endoscopy. Remember that you have to keep eating gluten for an accurate celiac disease diagnosis, so don't go gluten-free until your healthcare provider gives you the okay.

What Exactly Is an Endoscopy?

The term "endoscopy" refers to any technique that lets healthcare providers insert a medical instrument called an endoscope through an opening in the body (either through a natural opening like your mouth or sometimes through a surgical incision). This allows healthcare providers to look around and either see that everything is in order or possibly to identify a problem. Sometimes they even can fix a problem at the same time.

The endoscope itself is a thin, flexible tube with a fiber-optic light source and a tiny video camera on the tip. In addition to cameras, endoscopes have at least one channel through which tiny tools can be passed. These tools can be used to snip off a tiny sample for examination under a microscope, to control bleeding, to remove polyps, to stretch narrowed areas, and for many other therapies.

Upper gastrointestinal (GI) endoscopies are performed by gastroenterologists. During the procedure, your healthcare provider can examine the esophagus, the stomach, and the beginning of the small intestine (called the duodenum). As your healthcare provider advances the endoscope through the body, an enlarged view from the video camera on the tip of the instrument is displayed on a TV or computer monitor, giving a clear, detailed display. In addition to using the tools at the end of the scope to take small pieces of tissue for biopsy samples, the healthcare provider can also capture specific screenshots (still photos) of questionable areas.

Endoscopies can be performed in a healthcare provider's office, an ambulatory surgical center, or a hospital. Where yours is done will depend in part on whether you have other medical conditions that may need special attention.

Before Your Upper GI Endoscopy

Your healthcare provider will give you written instructions in advance on how to prepare. Generally, most healthcare providers ask that you stop eating and drinking for about eight to 10 hours before the procedure because food in the stomach will block the view through the endoscope and could even cause vomiting. You also may be told to stop taking aspirin, ibuprofen, or other blood-thinning medications for several days in advance.

For an upper GI endoscopy, you will not need to drink an electrolyte solution the night before, as you would if you were having a colonoscopy (which is an endoscopic examination of your colon).

You’ll be given sedatives right before the endoscopy, so you’ll need to have someone else drive you home afterward. You should plan on taking the entire day off from work. If you’re a parent with small kids at home, try to arrange to have someone stay with you that day to help take care of them so you can rest.

During Your Endoscopy Procedure

Before the procedure begins, your healthcare provider will give you a sedative to help you feel relaxed and drowsy. You may also have your throat sprayed with a local anesthetic.

During the procedure itself, you’ll be lying down, with enough blankets to keep you warm. In many cases, people even fall asleep. You may end up sleeping through the whole procedure. Even if you’re not completely asleep, you should feel little to no pain—in fact, most people don't even remember what happens during their endoscopies. Your blood pressure, pulse, and oxygen level will be closely monitored.

Usually, an upper GI endoscopy takes 15 to 20 minutes. You'll be given a mouthpiece to help keep your mouth open. Then the gastroenterologist will gently maneuver the endoscope through your mouth, your esophagus, your stomach, and into the first part of your small intestine. As the endoscope is slowly inserted, the air is also introduced, which helps the healthcare provider see better. To find out whether you have celiac disease, your healthcare provider will take some small tissue samples from your small intestinal lining, which the pathologist will later examine under a microscope. This part of the procedure, the biopsy, is painless.

After the Endoscopy

When your endoscopy is finished, you will rest in a recovery area until most of the sedative has worn off. You’ll be able to have something to drink, and you'll be fairly alert, but not alert enough to drive yourself home.

Before you leave, the healthcare provider will tell you how the procedure went, but you won’t get any biopsy results for several days. You’ll be given written guidelines that tell you how soon you can start eating regularly again, and when you can resume your usual activities. Some people feel no symptoms afterward. Others may have a mild sore throat or feel bloated for a short while.

Possible Complications

Here’s what the American Gastroenterological Association says about the risks associated with having an upper GI endoscopy: "Years of experience have proved that upper GI endoscopy is a safe procedure and complications rarely occur. These include perforation, puncture of the intestinal wall that could require surgical repair, and bleeding, which could require transfusion. Again, these complications are unlikely; be sure to discuss any specific concerns you may have with your doctor."