Jeremy

Woodward

Gastroenterologist

Gastroscopy

  • Gastroscopy is the name given to a type of 'endoscopic' investigation for examining the stomach. It is sometimes called an 'oesophago-gastro-duodenoscopy' or 'OGD' because the test can also examine the oesophagus (gullet) and the duodenum (the upper small intestine).
  • 'Endoscopy' is a word meaning 'looking inside' (Endo = inside; scopy = looking). Endoscopes are steerable thin tubes containing cables that allow images to be carried electronically from the end of the instrument to a television monitor. They also have lights at the end to illuminate the inside of the intestine. Channels allow air to be pumped in to distend the stomach or intestine to make it easier to visualise, and also water in order to clean the lens at the end. There is also an instrument channel to allow the passage of tools - for instance to take biopsy samples, make injections or grab foreign objects that may need to be retrieved.
    • Why do I need a gastroscopy? Gastroscopy allows direct visualisation of the inside of the oesophagus, stomach and duodenum as well as the opportunity to sample the lining by taking small (2-3mm) pieces to look at under the microscope ('biopsies'). If you are having difficulty swallowing or have vomited blood, you may need an urgent gastroscopy. The test is used to help evaluate causes of abdominal pain, vomiting, anaemia, diarrhoea (for instance due to parasitic infections or Coeliac Disease), and weight loss. It can be used to assess the future risk of developing oesophageal cancer in patients with acid reflux. Narrowed areas (strictures) can be stretched to allow you to swallow more easily, and internal bleeding can be stopped by injecting with adrenaline or applying cauterisation current or detachable metal clips. Sometimes, injection of Botox can be used to relax overactive muscle in the oesophagus (causing difficulty swallowing) or the Pylorus (the sphincter at the end of the stomach) that may result in vomiting.

      What does the test involve? Gastroscopy involves gently passing a flexible tube over the tongue, and into the gullet (the oesophagus) and then advancing into the stomach and just beyond into the upper small intestine. The patient lies on the left hand side on an examining couch and is either given a light intravenous sedative or just a local anaesthetic throat spray to numb the 'gag' reflex and to take away the natural anxieties associated with the procedure. A monitor clip is placed on a finger in order to check that the oxygen level in the blood remains constant, and it is usual to provide additional oxygen by nasal prongs or a tube throughout the procedure. A nurse supervises the mouth and airway and has a suction catheter to remove saliva from the mouth. The procedure is carried out as a day case. If the patient has received a sedative then they may need to recover for a while afterwards and may be a little drowsy for the rest of the day (although the sedative used - Midazolam - does wear off very fast). We would recommend that they do not drive themselves home, do have someone with them afterwards and do not put themselves or others at risk over the subsequent 24 hours - for instance signing important documents, cleaning gutters on a ladder or driving heavy machinery! If throat spray alone has been used, the patient is able to get up and leave as soon as the procedure is complete.
      The test is a little uncomfortable, but not painful.

      How long will the test take? A diagnostic gastroscopy only takes a few minutes, although if biopsies are required, this can take longer.

      What preparation is necessary for my gastroscopy? In order to have a clear view and to reduce the risks of the procedure it is important to have an empty stomach. We usually recommend fasting for 6 hours prior to the procedure but drinking water is generally not a problem up to 2 hours before the procedure). If sedation is to be used, it is important to have arrangements for collection and someone to be available at home afterwards. If you are diabetic, or taking medications to thin the blood (for instance, warfarin, low molecular weight heparin injections, Clopidogrel, Dagibatran), please tell the doctor as soon as possible.

      What are the risks involved with this test? Diagnostic gastroscopy is a very safe procedure. Some patients experience some mild and short lived discomfort in the throat afterwards and because of the air that is required to distend the stomach they may feel a little bloated. Serious complications are reported but are usually as a result of there being an abnormality already existent. These include perforation - making a hole in the wall of the oesophagus or stomach. Whilst perforation is potentially very serious and may require an operation to cure, the risk of such a complication is extremely low. It is usual to quote a risk of around 1 perforation in 1000 cases, but in experienced hands the rate is considerably lower than this. Bleeding from biopsy sites is also a very rare occurrence and usually settles spontaneously but might require a further endoscopy to treat.

      When will I know the results of the test? The doctor is usually able to tell you the findings of the test as soon as you are awake again afterwards. If biopsies have been taken, these may require 1-2 weeks for reporting.

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