Gastroscopy: The Basic Facts

This article is written in ordinary language and it is for anyone who wants to know the basic facts about this medical procedure. If there are issues which are not clear please feel free to contact you hospital or general practitioner who will be pleased to help you.

Definition:

A gastroscope is a pliable seeing instrument which is inserted into the patient’s stomach and the doctor “looks in” at the viewing end like a microscope. The beauty of the gastroscope is that it allows the doctor to look directly at the surfaces visually. Some conditions may be treated at time of examination.

A gastroscope does not take visual images like the X-ray machine. However, newer gastroscopes can be attached to cameras and pictures taken. These are usually used for initial assessment. Subsequent photographs are used to evaluate the benefits of interventions.

Preparing for a Gastroscopy.

1. The patient will need to empty his stomach and duodenum completely so that the examiner can examine them without obstruction from ingested foods. Fasting for six to eight hours, prior to the examination is the norm.
2. The patient must inform the examiner if any of the following conditions apply to him. Let the examiner know of all medications that the patient is taking.
3. The examiner must be notified of all heart and lung conditions. These will be necessary for the examiner to do a risk analysis.
4. Presence of any allergies or sensitivities to drugs
5. Presence of any other major disease
6. The examiner may ask the patient to sign a procedure consent form. This form usually includes a clause which states that the examiner can perform any other procedure which may become necessary during the course of the examination.

Length of Stay in a Hospital.

If a gastroscopy is being performed during the patient’s admission in a Hospital then he will need to stay in the hospital until the underlying condition is resolved. Generally, a gastroscopy is a day procedure and the patient is allowed home the same day.

In some countries patients are booked to show up in the examiner’s office where the procedure is to be performed a few hours before scheduled time. If this is the case then the patient must have been given the preparation instructions.

The tip of a gastroscope.

Gastroscopy – The Procedure.

A Registered Nurse will see the patient prior to the procedure to do a general check to make sure that all preoperative checks have been done. At this point the nurse may go through a check list of things which she is required to check

After the preoperative formalities are completed an Intra Venous Cannula will be inserted in the patient’s non-dominant hand. This will be used to administer the anaesthetic. The cannula is removed before the patient goes home.

The patient is made to lie on his left side before inserting the gastroscope. In this position the inflated stomach sits evenly on the “operating table”.

An “O-shaped” mouthpiece is inserted into the mouth to keep it open and to insert the gastroscope into the mouth, oesophagus, and finally the stomach. This device also prevents the patient from biting the gastroscope.

A local anaesthetic may be sprayed into the back of the patient’s throat and mouth if the procedure is to be done with the patient conscious.

Once the gastroscope is in the stomach the examiner will inflate the patient’s stomach with a mechanical pump which is attached to the gastroscope. When the stomach is inflated it becomes stretched and lesions are easier to see visually.

If the stomach is not clean then the examiner may need to do a stomach washout before proceeding with the examination.

The procedure lasts 20 to 30 minutes when the stomach is clear and there are no complications.

The patient is generally administered oxygen via a face mask. This is because the passage of the gastroscope via the oropharyngeal space reduces the air flow to the trachea.

Oxygen administration can be discontinued immediately after the procedure.

Post Gastroscopy Period.

The patient wakes up quickly after the anaesthesia has been reversed. He will need help maintaining his airway. A Registered Nurse is always in attendance, just in case things go wrong.

Initially the patient will be drowsy, sleepy and be disorientated to time, person and place. As he wakens he will be able to maintain his airway. He may have had a local anaesthetic sprayed into his oropharyngeal space. If this is the case do not drink anything. It is likely to enter the trachea and cause you problems breathing.

After a head to toe assessment, if everything is satisfactory, then the patient will be allowed to go home. A patient is not allowed drive at this point.

If the patient is in pain then appropriate medications will be given. Some patients may experience nausea and vomiting. Others will feel excessively sleepy.

Sorethroat and irritation at the back of the oropharynx are common. Generally, the patient can be discharged home about 45 minutes after the procedure.

Arrange for ambulance or a relative to take the patient home. This will obviously depend upon the patient’s living conditions.

A Gastroscope. There are many types of gastroscopes which are available on the market.

Discharged Home & Follow up.

It is usual to have a rest (few hours) and then resume normal house hold activities. Also, most patients are able to go to work the next day if there are no complications.

It is good practice not to drive or operate machinery for 24 hours because some anaesthetic gases are likely to make the patient drowsy. Consumption of alcohol is discouraged because it will have a synergistic effect. It may induce vomiting.

During the first night home a friend or relative should stay with the patient. Take the patient back to the hospital back if there are any difficulties.

Last but not least, the patient should not sign any legal document during this recovery phase.

The Follow-up.

The examiner will see the patient after the procedure. If there are no unusual findings he may choose to discharge this patient. However, if treatment is needed then a follow-up appointment will be made with the patient’s doctor or specialist.

At this time it is important for the patient to ask any specific questions he may have.

The examiner also sends a report to the patients doctor by mail or fax depending upon local policies and procedures.

The patient may be placed on a bland diet or other food restrictions. The patient is instructed to see his GP or specialist if the problem persists.

This information is non-specific and should not be used for diagnostic or treatment purposes. Only qualified and Registered medical practitioners are authorised to treat and diagnose patients.