Generality
Gastroscopy is a diagnostic test that allows the visual exploration of the upper digestive tract (esophagus, stomach and duodenum), in order to exclude or highlight suspected functional alterations or diseases; for this, we speak more correctly of esophagus-gastroduodenoscopy (EGDs).
In recent years, the traditional gastroscopic technique has been flanked by the so-called "trans-nasal gastroscopy", in which access to the upper tracts of the digestive tract takes place through an even thinner endoscope introduced through the nose.
Indications
Why do you run it?
Gastroscopy is performed when there is a suspicion of a pathology at the level of the esophagus, stomach or duodenum, for example to investigate some symptoms, such as haemorrhages (hematemesis = emission of blood from the mouth, melena = emission of dark and tarry stools), anemic pictures, pain, retrosternal burning, nausea and difficulty swallowing (dysphagia).
Among the main and most common lesions found during a gastroscopy, we mention: esophagitis, Barrett's esophagus, complications related to liver cirrhosis and portal hypertension (esophageal varices), esophageal neoplasms, gastritis, gastric ulcer, gastric neoplasms and duodenal ulcer .
Other times, gastroscopy is performed to monitor the evolution of an already diagnosed disease, therapeutic efficacy or to perform treatments that can be performed endoscopically; for example, the doctor can stretch areas affected by stenoses (esophageal narrowings), remove polyps (generally benign growths) or foreign bodies accidentally ingested, stop bleeding, inject drugs or place therapeutic aids, without forgetting the possibility of collecting tissue samples (biopsy ) for the detection of infections ( Helicobacter pylori ), for the verification of the good functioning of the intestine and for the diagnosis of abnormal-looking tissues, which can reveal pathologies such as celiac disease and pre-tumor or tumor lesions.
Preparation
How do you prepare for the exam?
The absence of food in the upper reaches of the digestive tract guarantees better visualization and diagnostic accuracy. For this reason, it is advisable to remain fasting avoiding ingesting food or drinks for at least 6-8 hours before the exam; the last meal before the gastroscopy should still be light and easily digestible (see the article on food digestion times). If the gastroscopy is carried out in the afternoon, a light breakfast is allowed, based on tea and rusks, or breadsticks by 7.00 am. It is good not to smoke before the exam.
In general, it is not necessary to stop taking any drugs that are taken as usual therapy; in this regard, please refer to the medical indications, since, for example, it may be necessary to correct or possibly suspend therapies with oral anticoagulants (coumadin, sintrom), antiplatelet agents (aspirin, ticlopidine or similar) or anti-inflammatory / painkillers (aspirin and similar). Before the examination you should not take antacid drugs (like maalox) or charcoal.
Other conditions that may require special precautions in view of an esophagus-gastroduodenoscopy are valvular heart disease, the presence of pace-makers, immunosuppression and diabetes (with adaptation of oral hypoglycemic drugs and insulin before the examination) .
On the day of the gastroscopy it is necessary to bring health documents to the clinic (binding, health card, etc.) and any clinical documentation (blood tests, previous endoscopic reports, radiological reports, etc.).
Immediately before the examination, the patient is informed of the procedures for performing the gastroscopy and the risks of this investigation, requesting consent to perform the examination. During the interview, the patient will take care to inform the doctor or healthcare professional of any medical treatment in progress, allergies and adverse drug reactions, previous illnesses and any endoscopic tests he has already undergone. The woman of childbearing age will also have to warn of any or suspected pregnancy.
How do you do it?
For a successful investigation, the patient should remain as relaxed as possible. Generally, he is asked to lie on his left side after anestheticization of the oral cavity with a spray or a candy to melt in the mouth; both can give the sensation of bitter taste, but are important for making the throat numb and attenuating the gag reflex.
Before the examination, any mobile dental prostheses (dentures) will have to be removed, as will the glasses, while electrodes and a bracelet will be applied to monitor vital signs (arterial pressure, heart rate). A protection mouthpiece will also be inserted between the teeth to protect them and prevent the endoscope from being bitten.
In most cases, the patient is subjected to a general sedation by intravenous injection of drugs, in order to make the gastroscopy more comfortable and increase the collaboration of the patient. While eliminating anxiety or in any case significantly reducing it, these drugs do not completely sleep the patient, who remains capable of responding to tactile stimuli and cooperating in verbal commands. Not infrequently, due to the effect of the drug itself, the patient forgets the experience or at least retains only a faded memory.
Very rarely, general anesthesia is used. If the patient prefers it, the esophagus-gastroduodenoscopy (EGDs) can also be performed without any sedation.
The examination begins with the introduction of the gastroscope into the oral cavity, which is then lowered with extreme caution along the esophagus, up to the stomach and the duodenum. At the gastric level, through the instrument, air will be introduced in order to stretch the walls and have a better view of them; inside, in fact, the gastroscope has channels that allow to pass, if necessary, special microstructures, water or air.
On the screen a very sharp color image appears, with a high resolution of the inside of the stomach, and possibility to memorize snapshots and movies.
Is it Dolorosa?
By itself, gastroscopy is not generally painful and does not in any way prevent breathing; even performing biopsies is not painful, as the mucosa has no nerves that perceive pain. However, especially in the absence of sedation, the examination still causes some discomfort, in particular during the insufflation of air in the stomach. Even the descent of the gastroscope itself can cause a certain tension, with a sense of pressure on the belly, which at times can be unpleasant. However, the most unpleasant part of the gastroscopy coincides at the moment in which the gastroscope must be "sent down" to the passage from the oral cavity into the esophagus, since voluntary swallowing - which facilitates the maneuver by minimizing discomfort - is generally associated with the appearance of a regurgitation stimulus.
The exam takes about 15-20 minutes and can be extended if special interventions are required for unexpected results. If necessary, the effect of the sedative may be antagonized by another drug.
At the end of the gastroscopy it is possible, for a few hours, to feel a sensation of abdominal swelling that will disappear spontaneously. Other minor complaints can also be complained of, such as a hoarse voice.
After gastroscopy
At the end of the gastroscopy, the doctor will inform the patient about the outcome of the examination and provide precise indications on the measures to be taken.
The use of sedative drugs during gastroscopy requires the most absolute abstention from driving and the use of machinery in the 24 hours following the examination. For the same reason, in this period of time the patient will not have to sign documents with legal value or engage in other activities that require an important state of attention and full lucidity.
After about an hour of gastroscopy, as soon as the sensitivity of the tongue and palate is reacquired, as well as the reflex of swallowing, the patient can eat normally; we recommend a light meal, without alcohol, and rest for the rest of the day. If a biopsy has been performed, the patient should avoid taking hot food, because it would increase the risk of bleeding.
If abdominal pain, dizziness, nausea occur in the hours following gastroscopy, or the elimination of black and soft stools is noted, it is important to contact the doctor or the nearest hospital immediately.
For what has been said, if the patient has been subjected to sedation, we reiterate the impossibility of returning home by personally driving the car, even in the absence of dullness and drowsiness.
Risks and complications
Is gastroscopy dangerous?
Gastroscopy is a safe and widely tested test. Only rarely can complications arise, the most common of which is the perforation of the stomach, which occurs once every thousand cases. The risk of complications is obviously greater in the case of operative gastroscopy (for example with biopsies), especially for the risk of bleeding or wounds (perforations), further favored by particular anatomical conditions (esophageal stenosis, Zenker's diverticulum, neoplasms). Bleeding is generally controllable endoscopically, and only in very rare cases may require surgery or a blood transfusion.
The presence of pre-existing heart or lung diseases can also increase the risk of complications. Limited, but not negligible, the risk of pneumonia secondary to the ingestion of material aspirated into the airways, and of cardiac arrhythmias. Other complications may be related to the type of sedation. More details about complications can be requested from the endoscopist doctor.
To guarantee the patient from the risk of infection transmission, all the accessories used during gastroscopy are single-use or sterilized, with particular care for environmental hygiene.
