Upper Gastrointestinal Endoscopy (Gastroscopy)

Upper gastrointestinal endoscopy is a medical procedure that allows a specialist gastroenterologist to examine the inside of the organs of the upper gastrointestinal tract – the oesophagus (gullet), stomach and duodenum (first part of small intestine).

 

The procedure is performed using a soft, thin, flexible tube called an endoscope. The endoscope has a high-definition camera at the tip along with a bright light source, which allows your specialist to obtain detailed images of the inner lining of these organs. It is the test of choice for evaluation of the structure and anatomy of the upper gastrointestinal tract.

 

Endoscopy is often used interchangeably with other terms such as gastroscopy, upper gastrointestinal endoscopy, and oesophago-gastro-duodenoscopy (OGD), but all refer to the same procedure.

 

What are the reasons to have an endoscopy performed?

There are three broad categories of reasons why endoscopy may be recommended for you.

 

1. Evaluation of symptoms arising from the upper gastrointestinal tract

   • Heartburn or suspected acid reflux

   • Difficulty in swallowing

   • Bloating

   • Pain in the upper abdomen

   • Blood loss from the gastrointestinal tract

   • Weight loss

   • Nausea and/or vomiting

2. Screening for cancer in those at higher risk

   • Longstanding reflux and/or Barrett’s oesophagus

   • Known precancerous conditions in the stomach (e.g. intestinal metaplasia or dysplasia)

   • Family history of oesophageal or stomach cancer

3. To perform treatment of known abnormalities of the upper gastrointestinal tract, including:

   • Strictures, or narrowings of the upper gastrointestinal tract

   • Polyps, or abnormal growths

   • Bleeding ulcers

   • Abnormal blood vessels in the gut causing blood loss

   • Varices, which are bulging veins found in the oesophagus and stomach which can cause blood loss

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How do I prepare for an endoscopy?

You need to stop eating for 6 hours before the procedure, but can continue to have small amounts of water and other clear fluids (e.g. apple juice) up until 2 hours before the procedure. Take your usual medications with a sip of water on the morning of the procedure. However, if you are on blood-thinning medications (e.g. Aspirin, Plavix (clopidogrel), Warfarin, Xarelto, Eliquis etc.) then speak to your specialist prior to the procedure as sometimes you will need to stop this.

 

What happens during an endoscopy?

Once you are comfortably asleep, your specialist will pass the scope through your mouth and throat into the oesophagus. The scope is then gently further advanced into the stomach and duodenum. The lining of the gut is washed with water sprayed from the tip of the scope, to ensure that every part can be clearly seen. The entire lining is closely inspected for any abnormalities. Modern endoscopes have accessories including a special light filter and optical magnification which can be turned on to allow a highly detailed image to be obtained. If necessary, biopsies can be taken through a channel in the endoscope. If abnormalities are noted, various therapeutic interventions can be performed at the same time (see below). The endoscopy usually takes 15-20 minutes in total.

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What type of therapy can be performed during an endoscopy?

A/Prof Sanagapalli is able to perform the following therapeutic procedures during an endoscopy procedure:

• Dilatation (or stretching open) is a procedure where abnormal narrowed sections of the upper GI tract are enlarged to help relieve blockages and improve symptoms. Most commonly, dilatation is used to treat strictures of the oesophagus (that cause difficulty swallowing). Dilatation may be performed either by use of a balloon that is passed through the channel of the endoscope and inflated with air; or by the use of a plastic cylindrical tube that is passed through the stricture.

• Stenting is a procedure where a self-expanding metal tube (stent) is deployed at the time of endoscopy into narrowed segments of the gastrointestinal tract (stricture). Depending on your condition, the stent may be left in place for weeks or months at a time. 

• Polypectomy, or the removal of polyps (growths) with a wire loop ‘snare’

• Insertion of feeding tubes for patients with conditions preventing them from eating normally

• Endoscopic therapy of achalasia

• Argon plasma coagulation, a form of thermal therapy used to treat abnormal blood vessels in the gut lining, which are a cause of bleeding and anaemia

• Ligation of oesophageal varices

• Injection of muscle relaxant for treatment of retrograde cricopharyngeus dysfunction (R-CPD), or the inability to belch syndrome