Minimally Invasive Surgery
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A gastroscopy (also called endoscopy) is done using a narrow, flexible, telescopic camera called a gastroscope. The gastroscope is swallowed and passed down your oesophagus into your stomach.
A gastroscopy can help find out what is causing symptoms such as :
- Indigestion (especially if you're aged over 55)
- Repeated vomiting or vomiting blood
- Difficulty swallowing
It's also used to check for certain gastrointestinal conditions such as :
Sometimes, a gastroscopy is used to confirm the results of other tests.
- Coeliac disease
- Barrett's oesophagus
- Early signs of cancer
Reasons For The Exam
Disorders of the upper digestive tract are quite common in our stressful society. Various factors such as diet, environment, and heredity contribute to these conditions. Gastroscopy is often useful in diagnosing and treating problems such as :
- Abdominal pain
- Bleeding from the digestive tract
- Cancers of the stomach or esophagus
- Chronic heartburn and indigestion
- Diagnosis and removal of stomach polyps
- Dilatation of esophageal strictures
- Gastritis, or stomach inflammation
- Hiatal hernia
- Removal of swallowed objects
- Trouble swallowing
- Treatment of the "Ulcer Bacteria"
- Ulcers of the esophagus
- Ulcers of the stomach and ulcers of the duodenum
- Unexplained chest pain
What are the alternatives to gastroscopy?
Depending on your symptoms, it may be possible to diagnose your condition using a different imaging test, such as an X-ray using a barium meal, or a CT (computed tomography), MRI (magnetic resonance imaging) or ultrasound scan.
Preparing for your procedure
Gastroscopy is usually done in a hospital as out-patient or day case. This means that you won't need to stay overnight.
Your hospital will write to you with instructions to follow before your gastroscopy. Your stomach needs to be completely empty so that your doctor can see the lining of your stomach and duodenum clearly.
You will be asked to follow fasting instructions. Typically, you must not eat or drink for eight hours before your test. You may be allowed occasional sips of water for up to an hour and a half before the procedure.
You may need to stop taking some prescribed or over-the-counter medicines for indigestion two weeks before your gastroscopy, as these medicines can hide problems that would otherwise be found during the gastroscopy. You can continue to take antacids (eg sodium alginate, Gaviscon). If you normally take other medication (eg tablets for blood pressure), continue to take this as usual, unless your doctor tells you not to. If in doubt, check with your doctor.
Gastroscopy may be done under local anaesthesia, which is usually given in the form of a throat spray. This completely blocks feeling from your throat area, but you will stay awake during the procedure. You may be offered a sedative to help you relax during the procedure. If you have a sedative, you will have very little memory of the test.
At the hospital your nurse may check your heart rate and blood pressure, take a blood sample and test your urine.
Tell your doctor if you're allergic to any medication and whether you have asthma, other lung disease, heart problems or arthritis affecting your neck. Also tell your doctor if you have any dental crowns, bridges or loose teeth. These may be damaged by the gastroscope, although special care will be taken to prevent this.
Your doctor will usually ask you to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead.
About the procedure
The procedure usually takes 10 to 20 minutes to complete.
Your nurse will ask you to take off your shirt or top and put on a hospital gown. He or she will ask you to remove dentures or dental plates, contact lenses, glasses and jewellery.
If you're having sedation, this is usually given through a small plastic tube (cannula) in a vein on the back of your hand. You should start to feel relaxed and drowsy almost immediately.
Sedatives can sometimes affect your breathing. While you're sedated, your doctor will monitor the amount of oxygen in your blood through a sensor on your finger and give you extra oxygen through a mask.
With you lying on your side and your head bent slightly forward, your doctor will place a mouth guard over your teeth before carefully putting the gastroscope into your mouth. Your doctor will ask you to swallow to help the gastroscope pass into your oesophagus and down towards your stomach. It's important to keep your head and neck still and not try to straighten it. You should be able to breathe normally during this test. A nurse will help the doctor by using a suction tube to remove excess saliva from your mouth during the procedure.
Air is pumped through the gastroscope and into your stomach to make it expand and your stomach lining easier to see. When this happens, you may briefly feel a sensation of fullness or nausea.
The camera lens at the end of the gastroscope sends images from the inside of your body to a monitor. Your doctor will look at these images to examine the lining of your oesophagus, stomach and duodenum.
If necessary, your doctor will take a biopsy (a small sample of tissue) and/or remove small growths of tissue called polyps. This is done using special instruments passed inside the gastroscope and is quick and painless, although you may feel a slight pinch. The samples will be sent to a laboratory for testing to determine the type of cells and if they are benign (not cancerous) or malignant (cancerous).
When the test is finished the gastroscope is taken out quickly and easily. The gastroscopy won't hurt but it may be a bit uncomfortable. You may belch during or after the procedure to expel the air that has been pumped in.
What to expect afterwards
You will need to rest until the effects of the sedative have passed. You will usually be able to go home when you feel ready. You will need to arrange for someone to drive you home.
It may take several hours before the feeling comes back into your throat. You shouldn't drink hot drinks until the local anaesthetic has worn off.
You should try to have a friend or relative stay with you for the first 24 hours.
If you have a biopsy or polyps removed, your results will be ready several days later and will usually be sent to the doctor who recommended your test. At the hospital, your doctor may discuss other findings from the gastroscopy with you before you leave, or you may be given a date for a follow-up appointment.
Recovering from a gastroscopy
If you need pain relief, you can take over-the-counter medicines, such as paracetamol or ibuprofen. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.
Sedation temporarily affects your coordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards. If you're in any doubt about driving, always follow your doctor's advice and please contact your motor insurer so that you're aware of their recommendations.
Most people have no problems after a gastroscopy, but you should contact your doctor if you :
- Cough up or vomit blood
- Have abdominal pain which gradually gets worse, or is more severe than any pain that you had before the test
- Develop a high temperature
What are the risks?
Gastroscopy is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications of this procedure.
These are the unwanted, but mostly mild and temporary effects of a successful procedure.
After having a gastroscopy you may :
- Have a numb mouth and tongue for a few hours
- Feel bloated, but this usually passes quite quickly
- Feel sleepy as a result of the sedative
- Have a sore throat for a few hours
This is when problems occur during or after the procedure. Most people aren't affected.
Your doctor will be experienced at performing gastroscopies, but even so, a few aren't successfully completed and may need to be repeated.
You may find that that it takes a little while for your heart rate and breathing to settle. You may need to have oxygen through a mask temporarily.
Other complications are uncommon but it's possible to :
- Have a reaction to the sedative, such as a skin rash, difficulty in breathing or heart problems.
- Damage, or very rarely, tear the oesophagus, stomach or duodenum, particularly if a biopsy is taken or a polyp is removed, which may need further surgery or treatment with medicines.
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