Gastroscopy

Dr Calvin Ong

mbbs M.Med (Surgery) MRCS FRCS

Indications Preparation Procedure Recovery Risks Results

What Is A Gastroscopy?

Gastroscopy is a medical procedure used to examine the lining of the upper gastrointestinal tract, including the oesophagus, stomach, and duodenum (the first section of the small intestine).

It involves using a gastroscope, a long, flexible tube with a light and camera, gently inserted through the mouth and guided down the throat into the stomach and duodenum. The camera transmits images to a monitor, allowing the doctor to inspect these areas for abnormalities such as inflammation, ulcers, or tumours and sometimes to perform treatments.

Indications for Gastroscopy

Gastroscopy is used for both diagnostic and therapeutic purposes.

Diagnostic Indications

Diagnostic indications involve using gastroscopy to identify the cause of gastrointestinal symptoms and conditions, aiding in the diagnosis of various esophageal, stomach, and duodenal issues.

Gastrointestinal Symptoms: Persistent symptoms such as abdominal pain, nausea, vomiting, heartburn, or difficulty swallowing (dysphagia) may require a gastroscopy to identify the cause.
Unexplained Weight Loss: Significant and unintentional weight loss can indicate serious gastrointestinal conditions, which can be diagnosed with a gastroscopy.
Anaemia: Iron deficiency anaemia of unknown origin may necessitate a gastroscopy to locate potential bleeding sources in the upper gastrointestinal tract.
Suspected Infections: Infections such as Helicobacter pylori, which can cause ulcers, are detectable with gastroscopy.
Monitoring Known Conditions: Patients with known gastrointestinal conditions, such as Barrett’s oesophagus, coeliac disease, or peptic ulcer disease, may have periodic gastroscopies to monitor disease progression or treatment response.

Therapeutic Indications

Therapeutic indications involve using gastroscopy to treat specific conditions or manage complications within the gastrointestinal tract.

Polyp Removal: Allows for the removal of polyps from the stomach lining.
Bleeding Control: Helps control gastrointestinal bleeding using methods such as clipping, cauterisation, or injection.
Stricture Dilation: Special instruments that are passed through the gastroscope can be used to dilate narrow areas (strictures) in the oesophagus or stomach.
Foreign Object Removal: Objects swallowed and lodged in the upper gastrointestinal tract can be removed using gastroscopy.
Feeding Tube Placement: Assists in placing a feeding tube directly into the stomach (percutaneous endoscopic gastrostomy or PEG) for long-term feeding needs.

Preparing for a Gastroscopy

Proper preparation is necessary to ensure accurate results. The preparation process typically includes:

Fasting

Patients must usually fast for at least 6 to 8 hours before the procedure, avoiding all food and drink, including water, to ensure an empty stomach and clear for examination.

Medication Adjustments

Certain medications may need to be adjusted or temporarily discontinued, especially blood thinners, which may raise the risk of bleeding during the procedure. Patients should consult their doctor about any current medications.

Allergy Check

Inform the medical team of any known allergies, especially to medications or anaesthetics, as these will influence the choice of sedatives or anaesthetic agents used during the procedure.

Medical History Review

A thorough review of the patient’s medical history, including past surgeries, chronic conditions, or recent illnesses, allows the doctor to anticipate and manage potential complications.

Day of the Procedure

Arrive at the hospital or clinic at the scheduled time for pre-procedure preparations, including paperwork and initial assessments. Make arrangements for transportation home due to the sedative effects.

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Step-by-Step Procedure

The gastroscopy procedure follows these steps for a thorough and safe examination:

Preparation

The patient is given a sedative through an IV to help them relax. A local anaesthetic spray is applied to numb the throat, and vital signs are monitored throughout the procedure. The patient lies on their left side and wears a mouth guard to protect their teeth.

Gastroscope Insertion

The doctor gently inserts the gastroscope through the mouth and guides it down the throat, sometimes asking the patient to swallow to help guide the tube.

Examination

The doctor uses the camera on the gastroscope to inspect the oesophagus, stomach, and duodenum. If necessary, small tissue samples (biopsies) are taken for further analysis, and treatments such as polyp removal or bleeding control can be performed.

Completion and Recovery

After the examination and any treatments, the gastroscope is carefully removed. The patient is monitored until the sedative wears off and they are stable enough to return home.

Post-surgical Care and Recovery

Proper care after a gastroscopy ensures a smooth recovery.

Immediate Care

Patients are monitored in a recovery area after the procedure until the sedative wears off. Mild throat soreness or discomfort is common and can be eased with throat lozenges or warm saline gargles. Start with small sips of water and gradually resume a normal diet, avoiding hot or spicy foods initially.

Recovery

Resting for the remainder of the day is advised due to lingering sedation effects. Avoid driving or operating heavy machinery. Normal activities can usually be resumed the next day, but avoid strenuous activities for at least 24 hours. Drink plenty of fluids to help flush out the sedative and stay hydrated, which promotes a quicker recovery.

Follow-up

The doctor will review the gastroscopy results with the patient, either immediately after the procedure or at a follow-up appointment. Biopsy results typically take a few days to a week. The doctor will contact the patient with findings and recommendations for further treatment or additional tests if necessary.

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Risks and Complications

While gastroscopy is generally considered a safe procedure, it carries some risks and potential complications. Understanding these risks helps in making informed decisions and recognising when to seek medical attention.

Common Risks

Common risks are typically mild and resolve quickly without requiring medical intervention, such as:

Sore Throat
Bloating and Gas
Minor Bleeding
Allergic Reactions

Complications

Complications from gastroscopy are rare, but patients must be aware of potential risks and know when to seek help. Seek medical attention if you experience:

Severe or persistent abdominal pain
Vomiting, especially if bloody or resembling coffee grounds
Difficulty swallowing or breathing
Fever and chills

Results and Follow-up

Interpreting Results

The doctor will discuss initial findings with the patient after the procedure. Visual inspection during the gastroscopy may reveal conditions such as inflammation, ulcers, tumours, or other abnormalities. If a biopsy was performed, tissue samples are sent to a laboratory for analysis. Biopsy results, which take a few days to a week, provide detailed information on infections, malignancies, or other cellular abnormalities.

Follow-up Care

The doctor will review both the visual findings and biopsy results, either immediately after the procedure or at a follow-up appointment. Based on the results, a treatment plan may be recommended, including medications, lifestyle changes, further tests, or additional procedures. For example, if Helicobacter pylori infection is detected, antibiotic therapy may be prescribed. Conditions like Barrett’s oesophagus or certain ulcers may require regular monitoring with repeat gastroscopies to assess treatment effectiveness and check for progression.

Dr Calvin Ong Jianming

Senior Consultant, Colorectal & General Surgeon

MBBS (S’pore)|

M.Med (Surgery)|

MRCS (Ireland)|

FRCS (Edin)|

王健名医生

Dr. Calvin Ong is a Senior Consultant with more than 15 years of surgical experience. He specializes in colorectal and general surgery, performing minimally invasive as well as advanced robotic surgeries for benign and malignant colorectal conditions, including inflammatory bowel disease, pelvic floor disorders, colorectal cancer, and hernia repair. He is dedicated to providing high-quality, personalised care for his patients.

Dr. Ong graduated with a Bachelor’s degree in medicine and surgery from the National University of Singapore in 2008 and completed his Masters of Medicine (Surgery) at the same institute. He finished his advanced specialist training in 2016 and became a fellow of the Royal College of Surgeons of Edinburgh.

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