This can be done if the data in your CSV has a unique key. For example, a 'Serial Number' column that has no duplicates, or an "Email" column with no duplicates, or in the best case an "Id" column with unique GUIDs or other ID values.
In general the process could be like:
1. Parse your CSV or Excel import.
2. Iterate through each row with a "Apply to Each" loop.
3. Filter your destination database (in your case a SharePoint List) to check for any existing rows that have the same unique key value as your current CSV row.
4. Add a compose action that counts the length of the returned array from your fitlered "Get Items" (use the Length() function on the value array output of the get items action.
5. Add a condition to create a new item in the list in the case that there are no existing rows with the unique key.
6. Add an update action to update either the existing Item or the newly created Item (you could do this by setting a variable to the Item ID of whatever the filter finds as well as setting the same variable to the ItemID of the created item in the create a new item condition branch).
The flow will go through your CSV rows, Pull a list looking for "ID eq '@{Item()?[CSV_Row_Unique_Id]}'", if it finds one it sets varItemIdToUpdate to the existing SharePoint ItemId, if zero
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