Gastroscopy or gastroscopy

Gastroscopy or gastroscopy is a method of examination of the upper digestive system (esophagus, stomach and duodenum) using a special endoscope; This so-called gastroscope is a long, thin, flexible plastic tube with video optics, with which the doctor can examine the inside of the organs.
Thanks to the camera and light source located at the end of the gastroscope, the images from inside the body can be transferred to a TV screen or PC monitor.

They show details of the inner lining of the esophagus, stomach and duodenum, allowing the doctor to determine the cause of the problem.

Understandably, many patients worry about the thought that they have to swallow the gastroscope. However, due to modern medical instruments and sedation, this examination is very well tolerated by most patients. After the examination, they are usually surprised at how easy the process was and now know that there is really no need to be afraid.

There are two procedures for performing a gastroscopy:

1. traditionally by mouth;
2. through the nose (transnasal).

What are the indications for gastroscopy? When is it carried out?

Gastroscopy may be recommended if symptoms occur that indicate a stomach disorder, such as difficulty swallowing or persistent abdominal pain.
Gastroscopy helps determine the cause of these symptoms.
Gastroscopy can also be used to treat various intestinal problems.
Doctors can use the gastroscope to insert small instruments to perform various procedures:

• repair of bleeding vessels and ulcers,
• widening of the esophagus in case of narrowing,
• food aid, if normal eating is not possible,
• Removal of benign growths (polyps) or cancerous tumors in the initial stages.

Why is it carried out?

Gastroscopy is a minimally invasive method that can be used to assess symptoms or confirm the diagnosis (diagnostic gastroscopy) or to treat a disease (therapeutic gastroscopy).

Diagnostic gastroscopy
A diagnostic gastroscopy is usually advisable if the symptoms indicate a disorder of the stomach, which may also affect the esophagus and the first section of the small intestine.

The most commonly studied symptoms include:

• Difficulty swallowing or pain when swallowing (dysphagia)
• persistent abdominal pain
• persistent nausea (feeling malaise)and breaking
• unexplained weight loss

Even if the family doctor suspects bleeding in the stomach or small intestine, a diagnostic gastroscopy can bring clarity. Prolonged bleeding can significantly reduce the number of red blood cells. This condition is called anemia.

The symptoms of anemia are:

• constant fatigue
• Shortness of breath
• Skin pallor
• irregular heartbeat

In some cases, sudden and heavy bleeding in the gastrointestinal tract leads to the following complaints:

• Haematemesis
• dark stools (digested blood)
• Sudden, acute abdominal pain that gets worse

Upon the appearance of these symptoms, diagnostic gastroscopy should be performed immediately.

Examination alternatives

The family doctor may schedule a barium X-ray of the upper digestive tract. This procedure is useful for investigating a section where a disorder is suspected; but the X-rays do not indicate all the problems. It is estimated that up to 30% of gastric and duodenal ulcers remain undetected on a standard X-ray examination of the upper digestive system.

Gastroscopy gives a much more accurate picture of the upper digestive system. The doctor does not have to worry about a “shadow” indirectly displayed on the X-ray, but can examine the upper section of the digestive system in the direct procedure and carefully examine the inner walls. This method of examination is much more thorough.

What needs to be considered when preparing for a traditional gastroscopy?

At least six hours before the examination, you should stop eating and drinking.
Anyone taking medication should consult their doctor. It may be necessary to discontinue the medications that increase the risk of internal bleeding two days before the examination.
These include: warfarin, aspirin and anti-inflammatory drugs from the group of nonsteroidal anti-inflammatory drugs (NSAIDs).
However, this depends on the individual circumstances, which must be checked in any case.
The patient must inform his doctor if there is a medical condition that forces him to take antibiotics before dental treatment; He may also have to take antibiotics before a gastroscopy.

Preparation for conventional gastroscopy (by mouth) As a rule,
the patient receives a notepad with the preparatory measures together with the appointment confirmation.

Medication
Oral medicines must usually be discontinued at least 2 weeks before gastroscopy.
This is necessary because the drugs may well mask problems that should become clear through gastroscopy. Antacids can continue to be taken until the examination.
Taking the following medications requires consultation with a doctor:

• medicines used to treat diabetes, such as insulin or metformin.
• Anticoagulants or anticoagulants (drugs that prevent the formation of blood clots), e.g. low doses of aspirin, warfarin or Plavix.
• You should refrain from nail polish at the examination appointment, because it affects the pulse oximeter, a device that is attached to the finger to measure blood saturation.

Nutrition
In order for the upper digestive tract to be easy to assess, the area viewed must be free of food.
Six hours before the examination you should not eat anything and two hours before you should not drink any more drinks.

Sedation
Gastroscopy can be performed under local anesthesia or intravenous sedation. The intravenously administered sedative does not let the patient fall asleep, but relieves the discomfort and provides relaxation. Both methods have their advantages and disadvantages.
In local anesthesia, the throat is anesthetized with lidocaine spray.

After intravenous sedation, the patient remains sleepy for a while after the examination. If the doctor discusses the examination results and treatment options with the patient, he may not yet be fully receptive and forgets what has been said; it is advisable to continue the doctor’s consultation at a later date in order to be able to discuss the situation in detail.
There is a low risk of excessive sedation: breathing can be suppressed, which can have serious consequences. With any medication, including local narcotics, there is a small risk of an allergic reaction.

General anesthesia is rarely performed.

Without sedation, the 5/10 minutes of examination are perceived as unpleasant. The main advantages are that the examination results and forms of treatment can be discussed with the patient immediately afterwards and the patient can return to his everyday activities immediately after the examination.

How does the traditional gastroscopy work?

A gastroscopy is usually performed by a doctor and nurse with special training.

Glasses, contact lenses and dentures must be removed. The throat can be anesthetized with the help of an anesthetic spray, a mouthpiece is inserted to protect the teeth.
The patient lies on the left side for the examination and a pulse oximeter may be attached to the finger to measure oxygen saturation and heart rate.

Then a sedative can be injected into the arm, the patient becomes drowsy and is not fully aware of the examination, he may not even remember it later, but he is able to follow the doctor’s instructions.
The doctor inserts the gastroscope into the throat and instructs the patent to swallow it so that it enters the lower part of the esophagus.

How is transnasal gastroscopy performed?

Shortly before the examination, a narcotic agent is sprayed into the nasal cavity. Then the doctor selects the nostril that is most suitable for inserting the gastroscope.

Advantages of the transnasal procedure
The advantages lie in the type of endoscope: it is a very thin instrument that can be inserted without anesthesia.
It has a smaller diameter (5-6mm) than the tube inserted through the mouth (9-10mm).
The smaller diameter makes it possible to insert the endoscope through the nose, which is much more comfortable for the patient than the conventional method through the mouth.
The introduction through the mouth is perceived by patients as a very invasive procedure.
In addition, in the conventional method, the presence of the instruments in the throat can cause nausea, nausea, difficulty breathing, belching and a lump in the throat.

List of benefits of transnasal gastroscopy

• There is no need for anesthesia, so it can also be performed on patients with allergic reactions, or if they want to start their activities, eat and drive immediately after the examination.
• There are no side effects such as nausea and vomiting because the endoscope is not inserted through the mouth.
• You can talk to the doctor and nurses during the examination.
• You can swallow without pain, even if a foreign body is perceived in the chest region.
• The discomfort in the stomach is less because the endoscope is more mobile.

Disease diagnosis

When the gastroscope is inserted into the upper digestive system, air is blown into the stomach during a diagnostic gastroscopy. In this way, the doctor can detect red spots, holes, lumps, occlusions and other abnormalities.
The doctor takes samples directly from conspicuous areas in order to have them examined microscopically afterwards (biopsy). Sampling does not cause pain.

Gastroscopy and biopsy of the duodenum for the diagnosis of celiac disease

If celiac disease is suspected and the patient has undergone blood tests – such as determining the number of specific antibodies – a gastroscopy and histological examination are performed to evaluate the inner wall of the duodenum (duodenum).

Marsh classification of biopsy results
In people suffering from celiac disease, a change in the inner wall of the intestine is noted. The following results are possible:

• Marsh 0: the small intestine wall is normal.
• Marsh 1: increased number of lymphocytes (white blood cells), but the intestinal villi are normal.
• Marsh 2: increased number of lymphocytes, the depressions in the small intestine wall are deeper than normal, but the length of the villi is normal.
• Marsh 3: the villi are getting shorter.
• Marsh 4: the villi are completely flattened or absent.

In adults, gastroscopy is essential to diagnose celiac disease, while in children it is not necessary because the specific blood tests are sufficient.

Treatment of bleeding varicose
veins

For bleeding from varicose veins (varicose veins), the doctor first uses the endoscope to identify the site of the bleeding.
If the varicose veins are located in the esophagus, the bleeding can be stopped by a rubber band ligation.
Together with the endoscope, a small rubber band is inserted to close the varicose veins and cut off the blood supply, so that further bleeding is avoided.
If the varicose veins are located in the stomach, a chemical substance (cylan acrylate) is injected into the bleeding region. Cylan acrylate is the active ingredient found in extra-strong adhesives available in the store.
It is extremely useful to seal holes and cracks in the human body as well.

Treatment of bleeding ulcers For bleeding ulcers
, a number of techniques are available, for example:

• Insertion of a probe through the endoscope to apply heat or small clips to stop bleeding.
• injection of a weak adrenaline solution around the ulcer to activate the process of clotting; the arteries contract and increase blood clotting.

During these processes, the doctor may inject a fast-acting medication to reduce stomach acid (so-called proton pump inhibitors) to prevent recurrent bleeding.

Narrowing (stenosis) of the esophagus In the case of constrictions in the esophagus, the doctor can insert devices together with the endoscope to expand the esophagus.
These instruments can also be used to insert a balloon or stent (hollow plastic or metal cylinder) that keeps the walls of the esophagus open.

Is a gastroscopy painful?

As a rule, gastroscopy is unpleasant, but not painful.

After gastroscopy

A gastroscopy takes about 5/10 minutes. At the end of the examination, the doctor carefully pulls out the gastroscope and the patient can recover from the effects of anesthesia in a recovery room.

After gastroscopy, the doctor may prescribe a series of examinations to control the effectiveness of treatment and possible complications; These include:

• X-ray of the chest
• Heart rate measurement
• Blood pressure

After that, the patient is either admitted to a department or discharged home.

Even if the patient feels awake, the sedative can remain in the body for up to 24 hours, causing drowsiness during this time.

The patient is not allowed to drive, operate heavy machinery or drink alcohol for a day.
Depending on the type of procedure, it may take a few days until a normal diet is allowed again.
The doctor will give more detailed information about dietary requirements.

How often does a gastroscopy have to be repeated?

In the case of a beret esophagus, the following examination program is planned:

• If there is no cell change (dysplasia), two gastroscopies are performed in the first year, then every three years.
• With low-grade dysplasia, gastroscopy must be performed after 6 months and repeated annually if there has been no regression.
• With high-grade dysplasia, it is necessary to perform a biopsy every 3 months for the first year; later, more time may pass before a recurrence if no cancer develops and the dysplasia remains stable.

If the patient suffers from severe atrophic gastritis, it is necessary to perform a gastroscopy with biopsy every 2 years.

With intestinal metaplasia, gastroscopy must be performed every 2 years, if the patient is still young or if there are cases of stomach cancer in the family.

With low-grade epithelial dysplasia in the stomach, it is necessary to perform a gastroscopy every 3 months for the first year, but you can stop if the control result was negative twice in a row.

Patients with gastric polyps should repeat gastroscopy after one year; it is checked whether there are relapses or smaller polyps have been overlooked.

What side effects and complications can occur with a gastroscopy?

Most gastroscopies go without problems.
Sometimes the patient suffers from a mild sore throat for a day or two.
The sedative may make you feel tired and sleepy for a few hours.
After a gastroscopy, there is a slightly increased risk of chest infection or pneumonia.

In rare cases, the gastroscope causes damage to the intestine. Bleeding, infection and perforation may occur.
If any of the following symptoms become apparent within 48 hours of a gastroscopy, seek medical advice immediately:

• Abdominal pain, especially with gradual exacerbation.
• Fever (increase in body temperature).
• difficulty breathing.
• Haematemesis.

Some patients have a heart attack or stroke during or immediately after gastroscopy. As a rule, this happens in elderly patients or in poor health. These complications are rare in the majority of healthy patients.

An allergic reaction to the sedative is rare.

• Reflux esophagitis or eosinophilic esophagitis
• Hiatal hernia or diaphragmatic hernia
• Esophageal achalasia