GASTROSCOPY OVERVIEW

A gastroscopy, often referred to as an upper endoscopy, OGD, or oesophago-gastro-duodenoscopy, is a procedure that allows a physician to directly examine the upper part of the gastrointestinal (GI) tract, which includes the esophagus (swallowing tube), the stomach, and the duodenum (the first section of the small intestine) (See the figure).

The doctor who performs the procedures, has special training in using an endoscope to examine the upper GI system, looking for inflammation (redness, irritation), bleeding, ulcers, or tumors.

 

REASONS FOR A GASTROSCOPY:

The most common reasons for a gastroscopy include:

• Unexplained discomfort in the upper abdomen
• GORD or gastroesophageal reflux disease, (often called heartburn)
• Persistent nausea and vomiting
• Upper GI bleeding (vomiting blood or blood found in the stool that originated from the upper part of the gastrointestinal tract)
• Bleeding can be treated during the endoscopy
• Difficulty swallowing; food/liquids getting stuck in the oesophagus during swallowing. This may be caused by a narrowing (stricture) or tumor. The stricture may be dilated with special balloons or dilation tubes during the endoscopy
• Abnormal or unclear findings on an upper GI X-ray, CT scan or MRI
• Removal of a foreign body (a swallowed object)
• To check healing or progress on previously found polyps (growths), tumors, or ulcers

 

GASTROSCOPY PREPARATION:

Your stomach should be empty during the procedure to make it possible to visualise the entire area and to decrease possibility of food or fluid being vomited into the lungs while under sedation (called aspiration).

You should be fasting for solids from 8 pm on the day before the procedure. You may drink clear fluids (no milk) up to 3 hours before your gastroscopy on the day of the procedure.

NB if you are also having a colonoscopy with your gastroscopy you should follow the preparation instructions for colonoscopy and not gastroscopy!

Do not hesitate to call the physician’s office or the endoscopy unit if there are questions. 

Medicines

You can take most prescription and non-prescription medicines right up to the day of the gastroscopy. Your doctor should tell you what medicines to stop.

You should also tell the doctor if you are allergic to any medicines. Some medicines increase the risk of heavy bleeding if you have a biopsy during the gastroscopy.

Ask your doctor how and when to stop these medicines, including Warfarin and Clopidogrel/Plavix®.

Transportation Home

You should arrange for a friend or family member to escort you home after the examination.

Although you will be awake by the time you are discharged, the medications used for sedation cause temporary changes in the reflexes and judgment and interfere with your ability to drive or make decisions (similar to the effects of alcohol).

 

WHAT TO EXPECT

Before the test, a doctor will review the test, including possible complications, and will ask you to sign a consent form. The nurse or doctor will start an IV line in your hand or arm.

Your blood pressure, heart rate and oxygen levels will be monitored during the test. The monitoring is not painful. For safety reasons, dentures should be removed before the procedure.

The procedure typically takes between 10 and 20 minutes to complete. The endoscopy is performed while you lie on your left side.

Sometimes the doctor will give a medication to numb the throat (either a gargle or a spray). A plastic mouth guard is placed between the teeth to prevent damage to the teeth and scope.

 

THE GASTROSCOPY PROCEDURE

The gastroscope is a flexible tube, approximately the thickness of the index finger.

The scope has a lens and a light source that allows the endoscopist to look into the scope to see the inner lining of the upper gastrointestinal tract, or to view it on a TV monitor.

Most people have no difficulty swallowing the flexible gastroscope as a result of the sedating medications. Many people sleep during the test; others are very relaxed and generally not aware of the examination.

The doctor may take tissue samples called biopsies (not painful), or perform specific treatments (such as dilation, removal of polyps, treatment of bleeding), depending upon what is found during the examination.

Air is introduced through the scope to open the esophagus, stomach, and intestine, allowing the scope to be passed through these structures and improving the doctor’s ability to see all of the structures.

You may experience a mild discomfort as air is pushed into the intestinal tract. This is not harmful and belching may relieve the sensation.

The endoscope does not interfere with breathing. Taking slow, deep breaths during the procedure may help you to relax.

 

GASTROSCOPY RECOVERY

After the gastroscopy you will be observed for one to two hours while the sedative medication wears off.

The medicines cause most people to temporarily feel tired or have difficulty concentrating and you should not drive or return to work after the procedure.

The most common discomfort after the examination is a feeling of bloating as a result of the air introduced during the examination.

This usually resolves quickly. Some patients also have a mild sore throat. Most patients are able to eat shortly after the examination.

 

GASTROSCOPY COMPLICATIONS

Upper endoscopy is a safe procedure and complications are uncommon.

The following is a list of possible complications:

• Aspiration (inhaling) of food or fluids into the lungs, the risk of which can be minimised by not eating or drinking for the recommended period of time before the examination
• The endoscope can cause a tear or hole in the tissue being examined. This is a serious complication but fortunately occurs only rarely
• Bleeding can occur from biopsies or the removal of polyps, although it is usually minimal and stops quickly on its own or can be easily controlled
• Reactions to the sedative medications are possible; the endoscopy team (doctors and nurses) will ask about previous medication allergies or reactions and about health problems such as heart, lung, kidney,or liver disease. Providing this information to the team ensures a safer examination.

The medications may produce irritation in the vein at the site of the intravenous line. If redness, swelling, or discomfort occurs, your should call your doctor

The following signs and symptoms should be reported immediately:

• Severe abdominal pain (more than gas cramps)
• A firm, distended abdomen
• Vomiting
• Any temperature elevation
• Difficulty swallowing or severe throat pain
• A crunching feeling under the skin of the neck

 

AFTER THE GASTROSCOPY

Most patients tolerate endoscopy very well and feel fine afterwards. Some fatigue is common after the examination, and you should plan to take it easy and relax the rest of the day.

The doctor can describe the result of the examination before you leave the hospital.

If biopsies have been taken or polyps removed your doctor will discuss further follow-up arrangements with you.
Adapted from www.uptodate.com