HAVING A GASTROSCOPY

Gastroscopy (also known as oesophagogastroduodenoscopy, OGD, upper endoscopy or endoscopy) is a test which allows the doctor to look inside your oesophagus (gullet), stomach and the upper part of the small intestine (duodenum). It is performed using a gastroscope, a flexible tube thinner than the little finger. The test itself takes an average of only about 5 minutes but you may have to stay in hospital for up to 2-3 hours. It is important that you do not have anything to eat or drink for 6 hours before the test is due to take place. The stomach cannot be adequately examined if it is full of food.

MEDICATIONS:

Most medications e.g. for the heart, blood pressure etc. should continue to be taken in the normal way with a small amount of water. Inhalers for asthma should likewise be continued. Please let us know if you take blood-thinning medications e.g. warfarin, aspirin or clopidogrel, or if you are a diabetic, especially one on insulin since special precautions regarding medication and diet may have to be taken . Please check with us or your doctor if you have any queries.

Endoscopic findings may be altered by medicines used for indigestion and peptic ulcers. Sometimes ulcers may heal partially and inflammatory changes may be modified by the medications taken, potentially masking the findings The following drugs should usually be stopped two weeks before the gastroscopy: cimetidine (Tagamet), ranitidine (Zantac), nizatidine (Axid), lansoprazole (Zoton), omeprazole (Losec) and pantoprazole (Protium). Often, we look for a germ called Helicobacter pylori. Tests for Helicobacter pylori are less accurate if you have taken antibiotics of any kind within the previous four weeks. If you have any queries, please let us know.

THE PROCEDURE:

False teeth must be removed. Please let us know if your nose is blocked, since nasal decongestant drops may help. A nurse will stay with you throughout the test. You will have to lie on your left side. A finger probe will be attached to monitor your heart rate and breathing. If you are going to receive sedation, a small plastic cannula will be inserted into a vein. A local anaesthetic spray may be given to the back of your throat. This has a sharp taste and may make your eyes water. A plastic mouthpiece will be placed between your teeth to keep the mouth slightly open. The doctor will then pass the endoscope into the stomach. There is usually no pain at all. However, you maybe uncomfortable and bloated and feel like retching for the few minutes of the test. You should breathe through the nose and not attempt to talk during the test. Sometimes biopsies, or specimens from the stomach lining, are taken, but this is painless.

ALTERNATIVE PROCEDURES TO GASTROSCOPY

A barium meal is sometimes used to examine the oesophagus, stomach and upper small intestine. It is less invasive than gastroscopy but involves the use of radiation. Gastroscopy is more accurate than X rays , and furthermore, biopsies cannot be taken with a barium meal, unlike with gastroscopy.

ANAESTHESIA AND SEDATION

Gastroscopy may be performed with local anaesthetic only, or with intravenous sedation. Intravenous sedation does not put you to sleep but makes you relaxed and reduces discomfort. There are advantages and disadvantages for each approach. Please let us know your preference or discuss with us after you have read and thought about the pros and cons of each alternative.

With sedation, you may be drowsy after the procedure. Although the doctor will discuss the findings and treatment plan with you after the procedure, you may not remember the conversation, having had sedation, and it is normally best to attend a follow-up clinic appointment for a full discussion. The doctor will however speak to a relative or friend if you wish. You may not drive for 24 hours afterwards and it is unwise to operate machinery or make important decisions. There is a small risk of over-sedation, which may suppress the breathing and be potentially serious. With any medication, including the local anaesthetic, there is a small risk of an allergic reaction.

Without sedation, there is greater discomfort during the 5 minutes or so of the test. The advantages are, firstly, that the findings and treatment can be discussed with you immediately afterwards, and, secondly, you can return soon after the procedure to full activity or even to work if you wish.

AFTER THE TEST

You will be able to eat and drink normally when your swallowing reflex has returned. This may take up to 30 minutes. For a few hours you may feel bloated from air introduced during the procedure. If sedation had been used you will probably go to sleep and wake up feeling rather groggy for the remainder of the day. (Please see previous section). You may also have a slight sore throat. However, if severe pain should be experienced in the neck, chest or abdomen, please contact your gastroenterologist, general practitioner, or local Accident & Emergency Department.

POSSIBLE SIDE EFFECTS OR COMPLICATIONS

These are uncommon, but include allergy to the drugs used, suppression of breathing due to the sedation and damage to crowned teeth and dental work.

There is a very small chance that the gastroscope will cause damage to your oesophagus (gullet) or stomach, causing perforation (tear) or bleeding. Surgical repair may then be required. Additionally, although there is a wide range of variability, endoscopic examination can be fairly stressful. As such, the effect on the heart and lungs may be comparable to a certain degree of physical exertion. This may be relevant in patients with asthma, bronchitis or heart disease. These side effects are very uncommon, but can be potentially serious or even life‑threatening. If there should be any problems or concerns after the test, please contact your general practitioner, gastroenterologist or local Accident & Emergency Department