Gastroscopy

What is gastroscopy?

Gastroscopy is a medical procedure used to examine the interior of the upper part of the digestive system, specifically the esophagus, stomach, and the beginning of the small intestine (duodenum). Therefore, the full name of this procedure is esophagogastroduodenoscopy (EGD). This is achieved using an instrument called a gastroscope or endoscope.

A gastroscope is a flexible tube with a light and a camera at the top, which is inserted through the patient’s mouth and carefully lowered through the esophagus to the stomach and duodenum. The camera on top of the gastroscope allows the doctor to visually evaluate the mucous membranes of these organs and identify possible abnormalities such as ulcers, polyps, tumors or inflammatory changes. Also, during gastroscopy, tissue samples (biopsy) can be taken for further analysis.

Gastroscopy can be performed in hospitals, clinics, or specialized centers for endoscopy.

Why is gastroscopy done?

Gastroscopy is performed for various reasons, including diagnostic and therapeutic purposes. Gastroscopy is commonly used to diagnose and monitor various gastrointestinal issues that have been previously identified.

The most common indications for performing gastroscopy are:

To diagnose the causes of unexplained abdominal pain. These may include gastritis (inflammation of the stomach), ulcers on the mucous membrane of the stomach or duodenum, or the presence of a tumor.
Chronic or frequent heartburn that does not improve with heartburn medications or dietary changes. Gastroscopy may be recommended to rule out other causes of symptoms, such as esophageal stricture (narrowing), esophageal hernia, or inflammation of the esophagus.
Difficulty swallowing food or feeling that food is “stuck” in the chest. Gastroscopy can be useful for assessing the condition of the esophagus, such as esophageal stricture (narrowing), esophageal diverticula or tumors.
Bloating and indigestion can occur due to GERD, lactose intolerance and other digestive conditions.
Frequent vomiting that is most often a symptom of gastroenteritis, food poisoning and GERD
Vomiting blood and the appearance of black stools, unexplained anemia, and/or a positive fecal occult blood test (FOBT). Gastroscopy is used to diagnose the source of gastrointestinal bleeding, which may include bleeding from the stomach, esophagus, or duodenum.
Chest pain behind the sternum that is not of cardiac or respiratory origin.
Loss of appetite and weight loss.
Monitoring of previously diagnosed polyps, tumors, ulcers, and other diseases of the digestive tract

During gastroscopy, a biopsy may be performed to obtain tissue samples. These samples are then sent for analysis to establish an accurate diagnosis, identify potential malignant tumors, or provide information about the nature of inflammatory changes and for the diagnosis of Helicobacter pylori (H. pylori) infection, which is the most common cause of gastric and duodenal ulcers.

Gastroscopy can be therapeutic, as the doctor may perform certain procedures during the examination to treat certain conditions or relieve symptoms.

Here are some examples of conditions that can be treated during gastroscopy:

Removal of polyps

Polyps are growths on the mucous membrane of the esophagus, stomach or duodenum. If polyps are found during gastroscopy, the doctor can remove them using special instruments, such as a polypectomy loop, to reduce the risk of developing cancer or alleviate symptoms.

Hemostasis (bleeding control)

If bleeding is observed during gastroscopy, the doctor may take therapeutic measures to stop the bleeding. This may include the use of coagulation techniques to seal (sealing) blood vessels, administration of injections to narrow blood vessels, or the use of other techniques to control bleeding.

Dilation of strictures

If a narrowing or stricture of the esophagus or another part of the gastrointestinal tract is identified during gastroscopy, the doctor can perform a procedure called dilation. This involves using special instruments to expand the narrowed segment, which can improve the passage of food and alleviate symptoms.

Stent placement

In some cases, gastroscopy is used to place a stent (metal tube) in the esophagus, stomach, or duodenum. A stent can help maintain an open passage through a narrowed segment and improve the flow of food and fluids.

How do I prepare for gastroscopy?

The preparation for gastroscopy typically involves several steps to ensure that your digestive tract is optimally prepared for the examination.

Several common guidelines that are usually given to patients before gastroscopy:

Inform your doctor about all medications you are taking and any health conditions you have. Some medications may affect the results of gastroscopy or increase the risk of complications. It is important to inform your doctor about all medications you are taking, especially anticoagulants (blood thinners), antiplatelet medications (e.g., aspirin), and nonsteroidal anti-inflammatory drugs (such as ibuprofen, diclofenac) so that their use can be adjusted before the examination.
Also, if you have certain health conditions, such as allergies, heart problems or diabetes, it is important to tell your doctor to adjust the guidelines for gastroscopy preparation. The doctor performing gastroscopy may require special preparation for the examination (blood count, consultation of a cardiologist, internist).
Reduce intake of food and fluids: The day before the examination, avoid consuming milk and dairy products, and have a light dinner (e.g., tea, toast). On the day of the examination, you should not eat, drink water, or smoke. It is recommended to have at least 8 hours of fasting from food and 3 hours from water before gastroscopy. Medications that the patient takes regularly can be taken with a small amount of water at least three hours before the examination. This is important to ensure that your digestive tract is empty, which allows better visualization of the mucosa and reduces the risk of aspiration.
If you have removable dentures, be sure to mention it.
If analgesia and sedation are used during gastroscopy, it is recommended to arrange transportation home. Do not drive yourself after the procedure until the effects of sedation have completely worn off.
It is important to follow the specific guidelines provided by your doctor or the clinic where the examination is performed, as protocols and instructions may vary. Talk to your doctor if you have any additional questions or concerns about preparing for gastroscopy.

Who performs gastroscopy?

Gastroscopy is performed by a team of healthcare professionals who play different roles during the procedure.

Gastroscopy is usually performed by specialist doctors gastroenterohepatologists or surgeons specializing in the digestive tract, and who are trained in this procedure. They are experts in diseases and disorders of the gastrointestinal tract and have experience in performing gastroscopies.
An anesthesiologist will be responsible for administering and monitoring anesthesia during the gastroscopy, which can be done under sedation or general anesthesia to provide comfort to the patient and prevent discomfort during the procedure.
Nurses or technicians specializing in endoscopy will help prepare the patient, assist the doctor during the procedure and provide care and support to the patient throughout the process. They may also be responsible for sterilization and preparation of endoscopic equipment.

If a biopsy is taken, the sample is sent for pathological analysis, usually performed by a pathologist, a specialist in pathology. Pathologists are physicians specialized in diagnosing diseases by studying tissues, cells, and organs under a microscope. They analyze tissue samples collected through biopsy, surgical tumor removal, or autopsy to establish a diagnosis and provide information about the nature of the disease.

All team members work together to ensure that the gastroscopy procedure is safe, efficient, and comfortable for the patient. Their collaboration and expertise play a crucial role in achieving an accurate diagnosis and providing appropriate therapy to patients.

How long does gastroscopy last?

The duration of gastroscopy can vary, but typically the procedure lasts between 5 and 20 minutes. The duration depends on the reason for the gastroscopy, the extent of the examination, the need for biopsy or therapeutic procedures, and the individual characteristics of the patient.

A simple diagnostic examination with gastroscopy usually takes about 5-10 minutes. If a therapeutic procedure is performed, such as removing polyps or control of bleeding, the procedure can take a little longer, up to 15-20 minutes.

Additionally, the time required for patient preparation before the procedure and the recovery time after the procedure should also be considered when assessing the overall time required for the entire gastroscopy procedure

What happens during gastroscopy?

The patient will be prepared for the gastroscopy, which may involve the placement of an intravenous line for sedation or anesthesia administration, removal of clothing, and an explanation of the procedure.

The patient will be placed in a lateral position, usually on the left side of the body, with the knees bent towards the chest. This position helps to relax the muscles of the lower esophagus and facilitates the passage of the gastroscope through this part of the gastrointestinal tract.

If necessary, the anesthesiologist will apply sedation or general anesthesia to keep the patient relaxed and comfortable during the procedure.

Before inserting the gastroscope, a local anesthetic is given, and a plastic mouthguard is placed between the patient’s teeth to protect the gastroscope tube and facilitate passage through the mouth.

The physician will carefully insert the gastroscope (endoscope) through the patient’s mouth and gently pass it down the esophagus, stomach, and duodenum. The gastroscope has a light source and optical fibers that allow the doctor to visually examine the inside of the gastrointestinal tract.

As the gastroscope passes through the gastrointestinal tract, the doctor will carefully visually examine the mucous lining. Images may be displayed on a monitor through the gastroscope, enabling the doctor to identify any abnormal conditions, scars, polyps, or other tissue changes.

If necessary, the doctor will take tissue samples from the mucous membrane of the gastrointestinal tract for further analysis. This is usually done using special instruments that are introduced through the gastroscope. Samples will be sent to the laboratory for histological analysis.

If certain conditions requiring therapy are identified during the examination, the doctor may perform specific therapeutic procedures during the gastroscopy, such as polyp removal, control of bleeding, dilation of strictures, or stent placement.

After the examination or therapy is completed, the gastroscope is carefully removed from the gastrointestinal tract.

After the gastroscopy, the patient will be monitored until the effects of sedation or anesthesia subside. If general anesthesia was administered, the patient will awaken in the anesthesia or intensive care unit before being transferred to the recovery area.

What happens after gastroscopy?

Immediate recovery after gastroscopy usually takes some time, and the patient often returns home the same day. Here are a few things you can expect during this period:

If you received sedation or general anesthesia during the gastroscopy, it may take some time to recover from the effects of these medications. The doctor will monitor you during this period and ensure that you wake up and recover safely before allowing you to go home.
After gastroscopy, some common symptoms may occur, such as mild sore throat, bloating, mild nausea, or temporary loss of appetite. These symptoms usually disappear relatively quickly and do not require any special treatment.
Your doctor will provide guidelines on what you can eat and drink after gastroscopy. It is usually recommended to start with light food and fluids to gradually return to a normal diet. Avoiding heavy meals, alcohol, and strenuous physical activities may also be recommended for the first few hours or days after the procedure.
Although complications are rare, it is important to be aware of the signs of possible complications and to contact your doctor immediately if you notice anything unusual. This may include severe or prolonged pain, bleeding, difficulty swallowing, or any other unexpected symptoms.
After gastroscopy, the doctor will inform you about the examination results and the possible need for further procedures, treatment, or follow-up examinations.
It is important to follow your doctor’s instructions for recovery and report regularly to appointments or consultations to ensure full recovery and further monitoring of your health.

What are the risks of gastroscopy?

Gastroscopy is generally a safe procedure, but like any medical procedure, there are certain risks that can occur.

If you received sedation or general anesthesia during the gastroscopy, there is a small risk of reactions to these medications. This can include allergic reactions, breathing problems, changes in blood pressure, or cardiac issues. However, such reactions are rare.
Although the instruments used for gastroscopy are sterile, there is a very small risk of infection. In extremely rare cases, there may be an infection of the gastrointestinal tract mucosa or an infection at the site of anesthesia injection.
In some cases, gastroscopy can cause minor bleeding at the biopsy sites or during therapeutic procedures. Usually, this bleeding is mild and stops on its own. In very rare cases, intervention may be needed to stop the bleeding.
During gastroscopy, there is a minimal risk of damage to the mucous membranes of the gastrointestinal tract or organs. Doctors usually handle a gastroscope very carefully to reduce this risk, but in some cases, perforation or tissue damage may occur.

It is important to note that these risks are very rare, and complications during gastroscopy occur very infrequently. Doctors are trained to recognize and respond to these complications to ensure patient safety. Before the gastroscopy, the doctor will have a detailed discussion with you about the risks and benefits of the procedure, as well as address any questions or concerns you may have.

What are abnormal results of gastroscopy?

Abnormal results of gastroscopy may indicate various pathological changes or diseases in the gastrointestinal tract.

Erosions or ulcers of the mucous membranes

Gastroscopy may reveal the presence of erosions (damage) or ulcers (wounds) on the mucous membrane of the esophagus, stomach or duodenum. These findings may be associated with conditions such as gastric ulcer, peptic ulcer, esophageal reflux disease or Helicobacter pylori infection.

Polyps

Gastroscopy can identify polyps, which are growths on the mucous membrane of the gastrointestinal tract. Polyps can be benign (non-cancerous) or precancerous, and in some cases can be malignant (cancerous). Removal of polyps during gastroscopy can be performed for diagnostic or therapeutic purposes.

Tumors

Gastroscopy can detect the presence of tumors in the esophagus, stomach or duodenum. Tumors can be benign or malignant (cancerous), and gastroscopy can help take tissue samples (biopsy) for further analysis and making an accurate diagnosis.

Changes in the esophageal mucosa

Gastroscopy can detect the presence of Barrett’s esophagus, a condition in which the esophageal mucosa undergoes significant changes due to chronic gastroesophageal acid reflux. This change increases the risk of developing esophageal cancer.

Changes in the distal part of the stomach

Gastroscopy can identify the presence of gastritis, inflammation of the stomach mucosa, or gastropathy, which are mucosal changes not associated with inflammation. These changes can be caused by infections, irritants, or other conditions.

Bleeding in the digestive tract

Gastroscopy can identify the presence of bleeding ulcers, ruptured veins (such as in esophageal varices), tumors, or other lesions that may be causing bleeding.

The doctor can accurately interpret and explain the results of gastroscopy. Based on abnormal findings, the doctor will make a diagnosis and suggest further steps, such as additional tests, treatment, or monitoring of the condition.

It is important to note that this is only a description of the general procedure of gastroscopy and may vary depending on specific circumstances, medical practices, and technology used. It is always best to consult with a doctor to get information about specific details and preparation for gastroscopy.

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