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Upper Gastrointestinal Endoscopy (Gastroscopy)

Introduction

Gastroscopy is a type of endoscopy - a procedure which allows a medical specialist to fully examine the oesophagus (the 'food pipe'), the stomach and the duodenum (the upper section of the small bowel).

Endoscopy is referred to as a 'minimally invasive' procedure, as it does not require conventional surgery, instead an instrument referred to as an endoscope, which is a long thin and flexible tube equipped with a small camera and light, and often small surgical tools that allow some procedures to be carried out during the endoscopy, for example taking tissue samples (biopsies), stop bleeding from an ulcer, removing polyps and investigating inflammation or other abnormalities of the oesophagus, stomach or duodenum.

During the procedure the gastroscope is introduced via the mouth and gently moved down to the section of the gastrointestinal tract that needs to be examined.

Endoscopic procedures such as gastroscopy and colonoscopy place less stress on the body compared to conventional 'open' surgery, and consequently procedures are quicker, recovery times are much quicker and there is no resultant scarring from surgical incisions.

Indications

Conditions affecting the upper digestive tract, that is the oesophagus, stomach and duodenum are generally investigated by gastroscopy. Typical symptoms of these conditions may include swallowing problems, nausea, reflux, indigestion, discomfort/pain in the abdominal area, bloating, bleeding or frequent vomiting. Gastroscopy is considered a more accurate diagnostic technique than X-rays.

Preoperative Instructions

In most cases patients are advised to take nil by mouth (no food, no liquid) for 6 hours prior to the procedure. While fasting, all the regular medications are taken with a sip of water. If the patient is diabetic special arrangements might be needed.

Procedure

Sedation is required for a gastroscopy procedure - this is a mild anaesthetic, and a local anaesthetic is applied to the back of the throat to overcome the gag reflex as the gastroscope is introduced via the mouth. A gastroscopy generally takes no longer than half an hour, with an observation period of 1-2 hours after the procedure before the patient is able to go home. You will be given oxygen to breathe and have your pulse monitored by a special machine throughout the procedure.

Risks associated with this procedure

Gastrointestinal endoscopy is usually simple and very safe with most people only reporting very mild discomfort at the back of their throat for a short period of time.

There are however some risks which include but are not limited to following:

Common risks and complications include:

  • Nausea and vomiting.
  • Faintness or dizziness, especially when starting to move after the procedure.
  • Headache.
  • Pain, redness or bruising at the sedation injection site (usually hand or arm).
  • Muscle aches.
  • Allergy to medications given at the time of the procedure.

Uncommon risks and complications include:

  • Bleeding at a biopsy site or at the site where a polyp has been removed. This is usually minor and can usually be stopped through endoscope. Rarely, surgery is needed to stop bleeding.
  • Pneumonia (lung infection) which, in most cases, be caused by vomit going into the lungs.
  • Damage to your teeth or jaw due to the presence of instruments in your mouth.
  • An existing medical condition that you may have getting worse.

Rare risks and complications include:

  • A tear or hole (perforation) through the wall of the food pipe, stomach or duodenum. This is very rare and may need surgery to fix and may require a longer stay in hospital.
  • Bacteraemia (infection in the blood). This will require antibiotics.
  • ‘Dead limb’ type feeling in any nerve, due to positioning with the procedure – usually temporary in nature.
  • Anaphylaxis (severe allergy) to medication given or material in contact with at the time of procedure.
  • Your procedure may not be able to be finished due to problems inside your body or because of technical problems.
  • There is a possibility that some defects or disease may be missed.
  • Other potential risks include a reaction to the sedation used and complications from pre-existing damage to other organs such as the heart, liver, lung or spleen.
  • Death, as a result of complications to this procedure is extremely rare.

Postoperative Instructions

Because of the effect of the sedation, you must not drive home after the procedure, make important decisions or sign any legal documents in the following 24 hours. You should therefore make alternative transport arrangements. Return to work on the day of the procedure is not recommended.