Gastroscopy

A Gastroscopy is a medical examination, also called Upper GI Endoscopy or Esophagogastroduodenoscopy, which examines the inside of the upper part of the digestive tract, made up of the stomach, oesophagus, and duodenum normally up to the second portion of it.

What is a Gastroscopy used for?

A Gastroscopy is prescribed for various reasons and represents one of the best diagnostic tools available in the medical field today. It can be requested for all the problems associated with the upper part of the digestive tract, as it provides the doctor with a clear and direct visual of the area during the examination, thanks to high definition, colour images.

In general, the problems for which a Gastroscopy may be requested are the following:

• Heartburn or indigestion;
• reflux;
• stomach pain;
• difficult or painful swallowing;
• bleeding;
• to diagnose ulcers;
• to diagnose tumours;

Traditional or transnasal endoscopies even allow the medical specialist to perform surgical procedures, so called operations. By using tools which are located within the endoscope, it’s possible to remove samples of tissues, in other words biopsies, carry out minor surgery, stop bleeding and finally perform emergency interventions.

Preparation for a Gastroscopy

The preparation for a gastroscopy includes a proper diet.

The patient must fast from 12 o’clock midnight the night prior to the procedure, and therefore cannot eat or drink anything solid or liquid, not even water. The patient can however continue to take their normally required prescription medication (ex. High blood pressure medication) with very little water. If the procedure is in the afternoon, the patient will still need to fast at least 5 hours prior to the procedure. They can however have a light breakfast, preferably plain biscuits, fruit juice, camomile or tea.

As for the evening prior to the exam, it is suggested that the patient have a light dinner, preferably a vegetable broth. Here is a list of foods to avoid and those that are permissible:

Foods to avoid:
– Pork meat
– Fried foods
– Aged cheeses
– Fast foods (burgers, Paninis,)

Suggested Foods
– Lean meat
– Fish
– Broth or consommé, low fat
– Tea and light tea biscuits
– Camomile

Interruption of medications

• For all patients: do not take antacids or sucralfate the day prior to the exam. Also medications which are “proton pump inhibitors” must be interrupted up to 5 days prior to the exam;
• For patients taking anticoagulant or blood thinning medications they must inform the endoscopy centre at least 7 days prior to the exam, especially if a biopsy, the removal of polyps, or other surgical procedures are scheduled or probable. The specialist will consider the temporary interruption of these medications, for how long and in what way.
• All other medications which are normally taken, can continue to be taken except if the specialist sees fit otherwise;

How is it performed?

Procedure

The exam can last anywhere from 10 to 15 minutes. This time frame can vary based on certain factors: if the examination does not include any surgical procedures the time required will be far less. Endoscopy is normally done in an outpatient situation and therefore does not require admission to hospital.

The patient is asked to lie down on their left side. The doctor or assistant will begin to insert the gastroscope into the patient’s mouth. What the camera records within the organs will appear on a screen, ready to be analysed in detail by the doctor. During the examination gas or water may be injected so as to provide better visualization of the organs.

A Gastroscopy is known to be an invasive test which may often require sedation, especially if done using a traditional method. Here is a list of different methods of sedation:

• Conscious sedation: is a mild sedative which is taken orally (in drops or pills), normally a few minutes prior to beginning the Endoscopy. This type of sedation is done using analgesic or hypnotic drugs, and is intended to calm the patient and have them relax, even if it will not put them to sleep completely. In certain cases (or on the request of the patient), stronger sedatives may be used, therefore any discomfort will be lessened even further.
• Deep sedation or anaesthesia: is a type of sedation which causes the patient to fall into a deep sleep, therefore eliminating any and all discomfort or pain. For this reason deep sedation is often referred to as anaesthesia. Deep sedation is much stronger than conscious sedation and therefore requires the presence of an anaesthesiologist who will inject the sedative in a continuous, controlled manner throughout the entire procedure. Deep sedation is done by administering the drug via an IV while the patient is lying down. The drugs used for deep sedation are obviously much stronger than those used in mild sedation, and therefore have more side effects or contraindications.

Transnasal Endoscopy

Transnasal Endoscopy is a minimally invasive and painless method, used as an alternative or in addition to traditional examinations; it tends to cause less discomfort and therefore is better tolerated by patients. But what are the differences between and transnasal and a traditional Endoscopy?

• Preparation: the same as the traditional method.
• Sedation: not necessary for this type of exam.
• Technique: the technical characteristics of the endoscope used in a transnasal endoscopy, which in the most recent models has a diameter of slightly over 4mm, allows for the insertion through the nostril, leaving the mouth free from interference and thus avoiding all the problems associated with the traditional exam such as the feeling of suffocating, gagging or retching, the feeling of constriction. The patient can speak and swallow during the transnasal procedure and thus maintain a stable emotional state and avoid anxiety or tension.
• Duration: similar to or slightly less than a traditional endoscopy.

Virtual endoscopy

A virtual endoscopy is not an endoscopic examination, but rather radiological. Consequently, it is possible to investigate the first part of the digestive tract (the food pipe) using a regular CT scanner. Virtual gastroscopies are only used diagnostically but not surgically, in that they do not allow for biopsies. They are only requested selected cases.

Endoscopic Videocapsules

The endoscopic videocapsule is a very particular type of test which consists of swallowing a capsule containing a video camera. The video camera makes it possible to see only certain parts of the stomach, even if only partially and in some cases not very clearly,. The endoscopic videocapsule is rarely requested as an alternative to endoscopy.

Gastroscopy and pain

Is a Gastroscopy painful?  

The exam is not painful but may cause discomfort due to the feeling of suffocating or gagging or retching caused by the insertion of the probe into the mouth and touching the back of the tongue. For this reason sedation is often suggested, not so with the transnasal technique.

Sedation actually allows the patient to relax, making them calmer and more cooperative during the exam. The lack of proper sedation may without a doubt impede the performance of the exam, above all at the moment of inserting the endoscopic probe into the oesophagus, because of the feeling of suffocating that it may cause. In certain situations such as patients who are particularly sensitive, this discomfort may be even stronger.

Pain after a Gastroscopy

After having had a Gastroscopy, there may be some discomfort or minor pain which will generally dissipate in the 24 hours following the exam. The most common symptoms can be the following:

• Mild stomach cramps;
• General bloating of the stomach;

The above mentioned symptoms may be stronger if during the examination the specialist had to perform one or more biopsies. If the symptoms intensify or do not dissipate, it is recommended to see your doctor.

Gastroscopy with biopsy

During an endoscopy it may be necessary to perform one or more biopsies. This procedure can be done at the same time as the endoscopy; it is completely painless and non-traumatic and can be done in just seconds.

Biopsies

They are useful above all when there are inflammations, ulcers, neoplasms and other conditions or pathologies of the digestive apparatus. By performing a biopsy, the gastroenterologist can remove samples of tissue and organic matter using miniaturized surgical tweezers, which will then be analysed to determine the presence of possible stomach problems. Actually the removed sample will be sent to a laboratory to analyse its structure, the possible presence of bacteria or other factors which led to the occurrence of pathologies or inflammations.

Gastroscopy and risks

What are the risks involved in a Gastroscopy?

Just like any medical examination, an endoscopy also has risks or rather complications, even if the possibility of that happening is close to null nowadays. Thanks to recent technological innovations and to progressive refinements in endoscopic techniques, the risk of complications has dropped notably. It is however fundamental, so as to avoid any risk whatsoever, to rely on specialists and centres of the utmost excellence.

Here is a list of possible risks:

• Infections caused by instruments that are not sterilized or improperly sterilized;
• Haemorrhaging caused by anything from improper procedures to accidents in the course of the endoscopy and in particular in the course of biopsies;
• Perforation of the intestine, also caused by improper procedures during the course of the examination;

If in the 48 hours following the exam pain, fever, vomiting blood or respiratory difficulties should occur, call your doctor immediately or go directly to the ER.

Most common side effects  

After the exam there may be some side effects, above all in subjects who are more sensitive to sedation. In particular:

• Most likely for a couple of days after the exam, the patient may have a bothersome sore throat;
• Most likely for a few hours after a traditional endoscopy the patient will feel tired or sleepy; this may be due to the aftereffects of sedation. For this reason it is necessary to have someone accompany the patient in the case of a Endoscopy under sedation.

Diet after a Gastroscopy

After a Gastroscopy, the patient can go back to their normal daily activities and to a regular diet. Unless the patient underwent sedation, they can even eat 30 minutes after the exam. In the case of sedation, it is recommended to wait at least two hours so that the organism can return to its normal functions. It is however a good idea in the hours immediately following the exam to avoid fatty foods, to not overeat and to avoid alcohol.

What to eat after a Gastroscopy?

It’s a good idea to help the stomach gradually take up its regular functioning by eating the following:

• Light foods like fruit, vegetables, and legumes;
• Pasta, lightly dressed;
• Broth or consommé, better if vegetable;
• White meat;
• Fish;