Gastroscopy

(Upper Gastrointestinal Endoscopy)

Upper gastrointestinal endoscopy (gastroscopy) is a commonly performed procedure allowing direct visual examination of the inside of the upper gastrointestinal tract (oesophagus, stomach and duodenum) using a flexible instrument through which a live image passes. Current endoscopes transmit the image electronically whereas earlier instruments transmitted the image along fibreoptic bundles.

What is the Purpose of Gastroscopy?

Gastroscopy has many purposes. It allows an examination of the upper gastrointestinal tract for abnormalities, which may be recorded on photograph. This procedure also allows the removal of polyps (small benign growths), injection of bleeding blood vessels, the taking of samples of tissue (biopsies) for examination by a pathologist, and dilatation of strictures in the oesophagus (gullet). Gastroscopy also allows insertion of a feeding tube into the stomach through the abdominal wall (PEG tube) for patients who are unable to eat. If any of these additional procedures are planned as part of your gastroscopy they should be discussed with you in advance.

How Are You Prepared?

Prior to the procedure you will asked not to eat or drink. This is to allow a satisfactory examination and to minimise the risk of vomiting during the test.

How is Gastroscopy Done?

A soft, thin flexible tube is passed into the stomach via the mouth. This takes about 5 minutes and is done under intravenous sedation (medication which may be used include midazolam, fentanyl, and propofol). Reactions to these medications are rare. After the procedure you must not drive or use machinery until the next day, or longer if you feel unsteady or tired the next day. If you object to the use of sedation you should discuss this with your doctor. Some patients tolerate gastroscopy without sedation.

Gastroscopies are usually done in a hospital, usually on a day case basis. You would be required to attend the hospital for about 3 hours if you have sedation for your gastroscopy. You will need to arrange transport to and from the hospital.

Are There Alternatives to Gastroscopy?

A barium meal x-ray of the stomach will give similar information but it is not as accurate in detecting ulcers and other abnormalities, and it does not allow biopsies to be taken. It does not require sedation or hospital admission.

Complications

Gastroscopy is extremely safe, however complications very occasionally occur. Complications are more common where a therapeutic procedure is performed such as dilatation of a stricture in the gullet, removal of polyps (polypectomy) from the stomach, or insertion of a PEG feeding tube.

Some complications of gastroscopy and related procedures include:

  • Reaction or sensitivity to medication used for sedation (this may affect your breathing briefly)
  • Perforation (puncture) of the lining of the gullet, stomach, or duodenum
  • Infection in the neck, chest or abdominal cavity following a perforation
  • Bleeding - if blood vessels are injected or a polyp is removed
  • Lung infections due to vomiting and aspiration during the procedure
  • Heart attacks, cardiac arrest, and breathing problems (very rare)
  • There are other very rare complications - please advise your doctor if you wish to be given more details

Everything will be done to minimise the risk of these complications. There are ways of detecting these complications early and specific treatments are available if they do arise. Very rarely there may be a need for hospitalisation, major surgery, intravenous feeding, or blood transfusion. Although death can result from complications of gastroscopy & oesophageal dilatation this is extremely rare.

Special Precautions will need to be taken if you:

  • suspect or know you are pregnant or if you are breastfeeding
  • have severe heart, lung, or kidney disease
  • have diabetes
  • have HIV infection, or you are immunosupressed
  • have lymphoma, leukaemia, or you are receiving chemotherapy
  • have had heart valve disease, a pacemaker, aortic graft or other blood vessel graft
  • have an artificial joint
  • bleed very easily or if you take blood thinning tablets (warfarin), aspirin, or arthritis tablets (your doctor may request you to ceases these)
  • are allergic or sensitive to any medication