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I will have a gastroscopy next week. What is the procedure?

"Gastroscopy" is the name of a procedure that allows the doctor to directly examine the inside of the stomach...

(Posted on 19 April 2007)

Q1. I will have a gastroscopy next week. What is the procedure?

A1. "Gastroscopy" is the name of a procedure that allows the doctor to directly examine the inside of the stomach. Other parts of the upper gastrointestinal tract, including the esophagus, the stomach and the duodenum, are usually examined in the same time.

During the procedure, the doctor would need to pass the gastroscope - a long flexible fiber-optic instrument about the thickness of a little finger - into the stomach through the patient's mouth. A side channel in the gastroscope allows the doctor to manipulate a small instrument to take tissue samples (biopsy), if necessary.

Gastroscopies may be performed in the operation theater of a hospital. More often nowadays, they are performed as "day cases" in special units. Undigested food can block the view of the stomach linings, so a period of fasting is necessary. The patient would need to change into a gown. To minimize discomfort, the doctor would spray a local anesthetic to the back of the throat. The nurse would then put a plastic guard in the mouth to protect the patient from biting the instrument. With the patient lying on one side, the doctor gently pushes the instrument down the patient's oesophagus, further into the stomach and then duodenum. Modern gastroscopes are quite thin and easy to swallow. The video camera at the tip of the gastroscope sends pictures to a screen.

The patients are fully conscious during the procedure. Most would prefer a mild sedation. Although the examination only lasts for 10 to 15 minutes, the patients would need to stay in the recovery room for another two hours or so before they can safely go home.

Q2. What kinds of disease can be diagnosed via gastroscopy?

A2. Gastroscopy is a safe and effective procedure. The doctor can see directly the inside of the whole upper gastrointestinal tract. The test is often ordered to investigate into the cause of symptoms of the upper gastrointestinal tract, such as indigestion, heartburn, vomiting or upper abdominal pain. The test can also find out the cause of suspected internal bleeding and unexplained anemia.

The sort of pathologies that can be confirmed or ruled out by gastroscopy includes:

Inflammation
Areas of inflammation show up as small red spots in the lining of the upper gastrointestinal tract. Gastritis is the inflammation of the stomach. If they are found in the esophagus or the duodenum, the condition is called esophagitis or duodenitis.
Ulceration
An ulcer is an open sore. It looks like a small, red crater on the lining of the duodenum or stomach. Ulcers may be caused by irritation, trauma, infection or cancer.
Tumors
A tumor is an abnormal growth of cells or tissues. Tumor growths may be benign (noncancerous) or malignant (cancerous).

We now know that inflammation, ulcers and even cancers of the stomach can be caused by bacterial infections. During gastroscopy, the doctor can perform a special test for the bacteria Helicobacter pylori. The doctor can also take tissue samples to examine for malignant cells under the microscope. The procedure has largely replaced older methods to look into the stomach by x-rays after the patient has swallowed a meal of barium.

Q3. I often hear that gastroscopy makes patients feel uncomfortable. What preparation do I need to do?

A3. The procedure only causes mild discomfort and is not painful at all. Some patients may find the hospital environment intimidating though. A gastroscopy can only be performed on an empty stomach, so you must follow the instruction to fast yourself (usually at least 4 to 6 hours) before the procedure. Discuss with your physician if you are on any long term medicine. You should not wear any jewelry and avoid heavy makeup. Dentures should be removed.

The local anesthetic spray may taste funny and cause numbness in the throat. Some people may feel like coughing or gagging when the instrument is passed into the throat. You may experience fullness or bloating during the procedure as air is pumped into your stomach. Some people have a mild sore throat for a day or two afterwards.

The discomforts are minimized by a sedative that is given intravenously shortly before the procedure. You may feel drowsy afterwards, so you should have somebody to accompany you to and from the hospital. It is normal to spit out spots of blood. If you vomit out large amount of blood, have severe abdominal pain, or is running a fever shortly afterwards, you should consult a doctor. There is a slightly increased risk of suffering from a chest infection or pneumonia after gastroscopy.

Source: Quality HealthCare