Gastroscopy
What is a gastroscopy?
Gastroscopy or “upper gastrointestinal endoscopy” is an examination of the inside of the gullet (oesophagus), stomach (gastrum) and the first part of the small bowel (duodenum). It is performed by using a thin, flexible fibre-optic instrument with a light source and camera at the end, called an endoscope, which the surgeon will pass through the mouth. This allows the surgeon/endoscopist to see whether there is any abnormality of or damage to the lining of the gullet or stomach and whether there are any ulcers in the stomach or duodenum. The procedure is painless and is usually done under a light sedative as a day-case. Occasionally the procedure can be performed without sedation. When sedation is used, the patient will not be able to drive or operate machinery for the rest of the day.
How is a gastroscopy performed?
Once intravenous access is obtained, a trained sedationist or anaesthetist will administer conscious sedation. This is not a full anaesthetic, but you will not experience any discomfort or have any recollection of the procedure. You will be asked to lie on your left side. Once sedated, the surgeon will pass the gastroscope from the mouth to the small bowel in a controlled manner. The procedure takes 5-10 minutes to complete.
Why is gastroscopy useful?
- The surgeon can study the mucous membrane (lining) of the gullet, stomach and duodenum from top to bottom.
- It can be used to diagnose inflammation, ulcers or tumours.
- It can also be used therapeutically in a variety of circumstances (see below).
- Gastroscopy shows the inside of the gullet, stomach and duodenum on a screen so that the mucous membrane (lining) can be studied thoroughly by the surgeon. This can also then be recorded or photographed and used for later comparison.
- Gastroscopy is effective, precise and very safe.
What are the indications for a gastroscopy?
Surgeons may use gastroscopy as either a diagnostic or a therapeutic procedure.
Diagnostic indications:
Patients are most often given a gastroscopic examination because of their indigestion/heartburn symptoms. The gastroscopy can be useful to confirm the presence of inflammation in the gullet and rule out Barret’s disease. Occasionally, the cause of indigestion is an ulcer, and it is now known that many ulcers are due to bacterial infection (Helicobacter pylori) in the stomach. A biopsy (a small piece of the lining of the stomach) may be removed during endoscopy and examined under the microscope in the laboratory to confirm a suspected diagnosis. A very small number of patients with indigestion will turn out to have cancer and, again, Dr Cooper may accurately diagnose a condition by doing a biopsy. Further investigation can then be planned to ensure the most effective treatment.
Other diagnostic indications include:
- Evaluating patients with difficult (dysphagia) or painful (onynophagia) swallowing.
- Investigating unexplained weight loss.
- Investigating the cause of hematemesis (vomiting of blood) or of iron deficiency anaemia.
- Investigating the cause melena (passing of black, tarry stool) or of occult blood in a patient’s stool.
- Suspicion of cancer or looking for primary cancer in a case of advanced metastatic (spread to other organs) disease.
- Diagnosis of coeliac disease.
Therapeutic indications:
Gastroscopy has gone from initially being a purely diagnostic procedure to where it has now become an important tool in the treatment of many conditions:
- Stopping bleeding from a stomach or duodenal ulcer via adrenaline injection, clipping of vessels, coagulation, etc.
- Treatment of oesophageal varices (dilated veins) by banding or sclerotherapy.
- Treatment of early oesophageal cancer by endoscopic mucosal resection.
- Stenting of advanced tumours of the gullet or stomach to relieve obstruction and improve nutrition.
- Widening the gullet if it is narrowed.
- Placement of covered stents to seal off oesophageal perforations/fistulae or anastomotic leaks.
- Placement of feeding (gastrostomy) tubes through the abdominal wall in patients who cannot swallow (percutaneous endoscopic gastrostomy or ‘PEG’ procedure).
Is a gastroscopy safe?
All procedures carry some risk, but outpatient diagnostic gastroscopy is extremely safe. Minor complications are uncommon, and major complications are almost unheard of.