Gastroscopy

GASTROSCOPY - a patient's guide
Dr Ross Roberts - Surgeon, The Oxford Clinic

What is it?

Gastroscopy is a procedure developed for investigating disorders of the oesophagus (gullet), stomach and the duodenum (the first part of the small bowel). A gastroscope is a flexible instrument, which has a minute video camera at the end, allowing a direct view and sampling of the lining. These samples can then be examined under the microscope or tested chemically, which makes the procedure very accurate in establishing a diagnosis.

How do I know if I need a gastroscope?

The best person to advise you about this is your family doctor. The usual indications for gastroscopy include:

Persistent vomiting - particularly if there is blood in the vomit

Abdominal pain suggestive of an ulcer

Difficulty in swallowing

Persisting heartburn or indigestion (see article on gastroesophageal reflux)

Black bowel motions

Unexplained blood loss or anaemia

To investigate certain causes of weight loss

Chest pain not caused by heart disease

Suspected infection of the stomach (see below)

What happens before a gastroscopy?

Your doctor will want to know if there are any conditions that would increase the risk of gastroscopy. These would include:

Diabetes

Asthma or other lung disease

Heart disease

Bleeding disorders

Medication allergies

Previous surgery

Medications e.g. warfarin, lithium or insulin

To allow an adequate view, and for safety purposes, your stomach must be empty during a gastroscopy. You should therefore avoid all food and drink for 8 hours before the examination.

What happens during a gastroscopy?

When you arrive at the endoscopy unit you will be changed into a gown to protect your clothes. The procedure will be explained to you again and you will be asked to give written consent. Most people prefer to have sedation during the procedure. This is not obligatory however. Often an anaesthetic agent will be used to numb the throat and reduce gagging. You will be drowsy but conscious during the gastroscopy. Often people have no recollection of the event afterwards due to the sedation. This effect can last for the rest of the day.

It is illegal to drive while under the influence of sedation and you will need to make alternative arrangements to get home. It is also advisable that you do not use public transport, operate dangerous machinery or go back to work that day. You should avoid making important decisions during this period.

The instrument is passed through the mouth. A mouth guard is used to protect the teeth. Dentures should be removed. Gastroscopy can be uncomfortable but is not usually painful. Some people experience a desire to cough or gag when the instrument is passed into the oesophagus. If possible this impulse should be suppressed as a sore throat can result. Most endoscopists use video monitors now to observe the findings and you can watch this if you want to.

During the procedure small samples will be taken in most cases. These will be examined by the pathologist and tested for the presence of infection. The most common infection of the stomach is by a bacteria known as Helicobacter pylori which is associated with an increased risk of ulcers.

After the procedure you will be allowed to drink and eat soft foods once the sedation has worn off. While a gastroscopy only takes about 15 minutes to perform you will need to allow about 2 hours because of the recovery period.

What symptoms can I expect after a gastroscopy?

The effects of the sedation can last for the rest of the day leaving you feeling drowsy. During this time you should avoid alcohol. You may have a sore throat especially if there was a lot of gagging during the gastroscopy. This normally resolves in a few days. Most people feel a bit bloated from the introduced air. If you have severe pain or any other worrying symptoms you should contact either the doctor who did the gastroscopy or your family doctor.

What are the risks of gastroscopy?

In the hands of an experienced endoscopist the risks are very low. For a diagnostic gastroscopy the risk of developing a major complication is about 2 in every 1000 gastroscopies. The risk of dying is approximately one person for every 10 000 gastroscopies performed. You should be aware of the following risks:

Bleeding

Perforation

Aspiration (inhalation of liquid)

Oesophageal injury

Sore throat

Certain disease of the oesophagus and stomach such as strictures (narrowing), cancer and obstruction increase the risk of perforation and medications such as warfarin and aspirin increase the chances of bleeding.

In summary:

Gastroscopy is a very common, safe procedure which is also a very accurate method to diagnose disorders of the oesophagus, stomach and duodenum. While there are certain risks associated with this procedure they are outweighed in most instances by the advantages of establishing the correct diagnosis. You are encouraged to discuss this procedure further with your family doctor.