Having a Gastroscopy
Gastroscopy 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.
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 are on blood-thinning medication e.g. warfarin, aspirin or clopidogrel, or if you are diabetic, especially if on insulin, as special precautions requiring medication and diet may have to be followed. Please check with ourselves or your doctor if you have any queries.
Endoscopic findings may be affected by medicines used for indigestion and peptic ulcers. Ulcers may have healed and inflammatory changes resolved. In general, we recommend that the following drugs be stopped 2 weeks before the test: cimetidine (Tagamet), ranitidine (Zantac), nizatidine (Axid), lansoprazole (Zoton), omeprazole (Losec) and pantoprazole (Protium). Often, tests are taken to look for a special germ called Helicobacter pylori. These tests are less accurate if you have taken antibiotics of any kind within the previous four weeks. If you have any concerns, please let us know.
False teeth must be removed. Please let us know if your nose is blocked, as decongestant drops may help. A nurse will stay with you throughout the test. You have to lie on your left-hand side. A finger probe will be attached to monitor your heart rate and breathing. If you are going to receive sedation, a small needle 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 no pain at all. However, you will feel like retching, bloated and quite uncomfortable 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 entirely painless.
ALTERNATIVE 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. In most situations, gastroscopy is more accurate than X rays and biopsies cannot be taken with the latter.
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 Parkside Hospital at 8971 8000. Outside working hours please contact the Accident & Emergency Department of your local hospital or your general practitioner.
POSSIBLE SIDE EFFECTS
These are very uncommon. There is a slight risk to crowned teeth and dental work. Other problems include drug allergy, over-sedation with suppression of breathing, and the possibility of damage to the gullet or stomach by the gastroscope, causing perforation (tear) or bleeding. The latter complications may necessitate surgery. Also, 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 to patients with asthma, bronchitis, and heart disease.