Gastroscopy

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Introduction

Introduction

A gastroscopy is a procedure where a thin, flexible tube called an endoscope is used to look inside the oesophagus (gullet), stomach and first part of the small intestine (duodenum).

It's also sometimes referred to as an upper gastrointestinal endoscopy. 

The endoscope has a light and a camera at one end. The camera sends images of the inside of your oesophagus, stomach and duodenum to a monitor.

Why a gastroscopy may be used 

A gastroscopy can be used to:

A gastroscopy used to check symptoms or confirm a diagnosis is known as a diagnostic gastroscopy. A gastroscopy used to treat a condition is known as a therapeutic gastroscopy.

Read more about why a gastroscopy may be used.

The gastroscopy procedure

A gastroscopy often takes less than 15 minutes, although it may take longer if it's being used to treat a condition.

It's usually carried out as an outpatient procedure, which means you won't have to spend the night in hospital.

Before the procedure, your throat will be numbed with a local anaesthetic spray. You can also choose to have a sedative, if you prefer. This means you will still be awake, but will be drowsy and have reduced awareness about what's happening.

The doctor carrying out the procedure will place the endoscope in the back of your mouth and ask you to swallow the first part of the tube. It will then be guided down your oesophagus and into your stomach.

The procedure shouldn't be painful, but it may be unpleasant or uncomfortable at times. 

Read more about how a gastroscopy is performed.

What are the risks?

A gastroscopy is a very safe procedure, but like all medical procedures it does carry a risk of complications.

Possible complications that can occur include:

  • a reaction to the sedative, which can cause problems with your breathing, heart rate and blood pressure
  • internal bleeding
  • tearing of the lining of your oesophagus, stomach or duodenum (perforation)

However, serious problems are rare, occurring in less than 1 in every 1,000 cases.

Read more about the risks associated with a gastroscopy.

Why a gastroscopy is used

Why a gastroscopy is used

A gastroscopy can be used to check symptoms or confirm a diagnosis, or it can be used to treat a condition.

Checking symptoms

A gastroscopy may be recommended if you have symptoms that suggest a problem with your stomach, oesophagus (gullet), or the first section of your small intestine (duodenum).

Problems that are sometimes investigated using a gastroscopy include:

Diagnosing conditions

A gastroscopy is also used to help confirm (or rule out) suspected conditions, such as:

As well as examining the oesophagus, stomach and duodenum, the endoscope (a thin, flexible tube that's passed down your throat) can be used to remove small samples of tissue for testing. This is known as a biopsy.

Treating conditions

A gastroscopy can also be carried out to treat some problems affecting the oesophagus, stomach and duodenum.

For example, a gastroscopy can be used to:

  • stop bleeding inside the stomach or oesophagus, such as bleeding caused by a stomach ulcer or enlarged veins (varices)
  • widen a narrowed oesophagus that's causing pain or swallowing difficulties - this can be caused by GORD, oesophageal cancer, or radiotherapy to the oesophagus
  • remove cancerous tumours, non-cancerous growths (polyps) or foreign objects
  • provide nutrients by way of a feeding tube, when a person is unable to eat in the normal way

How a gastroscopy is performed

How a gastroscopy is performed

Instructions about how to prepare for a gastroscopy should be included with your appointment letter.

Phone the hospital if there's anything you're unsure about.

Preparing for a gastroscopy

If you're referred for a gastroscopy, you'll be told whether you need to stop taking any of your medications beforehand.

You may need to stop taking any prescribed medicines for indigestion for up to two weeks before the procedure. This is because the medication can mask some of the problems that a gastroscopy could find.

If you're taking any of the following medications, you should phone the endoscopy unit before your appointment, because special arrangements may need to be made:

It's important that your stomach is empty during a gastroscopy, so the whole area can be seen clearly. You'll usually be asked not to eat anything for six to eight hours before the procedure, and to stop drinking two to three hours before the procedure - follow the instructions given to you by the hospital.

The procedure

A gastroscopy often takes less than 15 minutes, although it may take longer if it's being used to treat a condition.

The procedure will usually be carried out by an endoscopist (a healthcare professional who specialises in performing endoscopies) and assisted by a nurse. You'll meet the nurse before the procedure and they'll be able to answer any questions you have and you'll also have an opportunity to ask the endoscopist.

local anaesthetic spray will be used to numb your throat for the procedure and you'll be asked beforehand if you'd like to have a sedative injection. Young children may have the procedure under general anaesthetic, which means they'll be asleep while it's carried out.

The sedative will help you feel drowsy and relaxed during the procedure, but you'll need to stay in hospital for a bit longer while you recover, and you'll need someone to pick you up from the hospital and stay with you for at least 24 hours. You won't able to work or drive during this period (see below).

Before the procedure starts, you'll be asked to remove any glasses, contact lenses and false teeth. You won't usually need to get undressed, but you may be asked to wear a hospital gown over your clothes.

The local anaesthetic spray is then given and a small plastic mouth guard placed in your mouth, to hold it open and protect your teeth.

You'll be asked to lie down on your left-hand side and the endoscopist will insert the endoscope into your throat. They'll ask you to swallow it to help move it down into your oesophagus. This may be uncomfortable at first and you may feel sick or gag, but this should pass as the endoscope is moved further down.

Diagnosing a condition

If the gastroscopy is being used to diagnose a certain condition, air will be blown into your stomach once the endoscope is inside. This allows the endoscopist to see any unusual redness, holes, lumps, blockages or other abnormalities.

It may feel a bit uncomfortable when the air is blown into your stomach, and you may burp or feel bloated. This should start to improve once the procedure is finished.

If abnormalities are detected, a tissue sample (biopsy) can be removed and sent to a laboratory for closer examination under a microscope. You won't feel anything while the sample is removed.

Treating bleeding varices

If you have bleeding varices (enlarged veins), the endoscopist will use the endoscope to locate the site of the bleeding.

They can then stop the bleeding by either tying the base of the varices with a small rubber band (band ligation), or injecting them with a chemical that seals the hole or tear in the blood vessel (sclerotherapy).

Treating bleeding stomach ulcers

If you have bleeding stomach ulcers, a number of techniques may be used to treat them. For example:

  • a probe may be passed through the endoscope to seal the ulcer with heat, or small clips may be used to stop the bleeding
  • medication may be injected around the ulcer to activate the clotting process

During the procedure, you may also receive an injection of an acid-reducing medication called a proton-pump inhibitor (PPI) to stop the bleeding recurring.

Widening the oesophagus

If you have a narrowed oesophagus, the endoscopist can pass instruments down the endoscope to help stretch and widen it.

The instruments can also be used to insert a balloon or stent (a hollow plastic or metal tube) to hold the sides of your oesophagus open.

Afterwards

After the procedure, you'll be taken to the recovery area.

If you didn't have a sedative, you can usually go home soon after the procedure is finished.

If you had a sedative, you'll need to rest quietly for a few minutes or hours until the sedative has worn off. You'll also need to arrange for someone to take you home and to stay with you for at least 24 hours.

Even if you feel very alert, the sedative can stay in your blood for 24 hours and you may experience further episodes of drowsiness. You therefore shouldn't drive, operate heavy machinery, or drink alcohol during this time.

Before you're discharged, the nurse or doctor may be able to explain the results of the procedure to you. Sometimes, you may need to have an appointment with the doctor or your GP a few days or weeks later to discuss the results.

You'll be told if you need to make any changes to your diet during the hours or days after going home.

When to seek medical advice

It's normal to feel bloated or have a sore throat for a day or two after a gastroscopy.

You should contact your GP or the endoscopy unit immediately if you develop signs of a more serious problem, such as:

Read more about the risks of a gastroscopy.

Risks of a gastroscopy

Risks of a gastroscopy

A gastroscopy is a very safe procedure and the risks of serious complications are small.

If it's used to diagnose a condition, it has less than a 1 in 1,000 chance of causing complications.

A gastroscopy used to treat a condition is more invasive and has a higher risk of complications. However, the risk is still relatively small, at around 1 in 100.

Some of the possible complications of a gastroscopy include:

  • adverse effects from sedation
  • bleeding
  • perforation (tearing)

These are described below.

Sedation

Sedation is usually safe, but it can occasionally cause problems, such as:

  • feeling or being sick
  • a burning sensation at the site of the injection
  • small particles of food falling into the lungs and triggering an infection (aspiration pneumonia)
  • an irregular heartbeat
  • breathing difficulties

Very rarely, complications from sedation can result in a stroke or heart attack.

Bleeding

Sometimes, during a gastroscopy, the endoscope can accidentally damage a blood vessel, causing it to bleed. However, significant bleeding is very rare.

Signs of bleeding can include vomiting blood and passing black or "tar-like" stools.

The site of the bleeding can usually be repaired during a further gastroscopy. A blood transfusion may also be required to replace lost blood.

Perforation

During a gastroscopy, there's a very small risk of the endoscope tearing the lining of your oesophagus, stomach or the first section of your small intestine (duodenum). This is known as perforation.

Signs of perforation can include:

  • neck, chest or stomach pain
  • pain when swallowing
  • a high temperature (fever) of 38C (100.4F) or above
  • breathing difficulties

If the perforation isn't severe, it can usually be left to heal by itself. You may be given antibiotics to prevent an infection occurring at the site of the tear. Surgery may be needed to repair more serous perforations.