Gastroscopy is a primarily diagnostic but also therapeutic procedure using an endoscopic camera to inspect the stomach and esophagus. Gastroscopy is the technique of choice to examine diseases of the esophagus, stomach and duodenum. For the following complaints, gastroscopy can help to find the cause and the right therapy: In addition, gastroscopy can be used to clarify the possible causes of suspected inflammation of the stomach lining, such as infection with Helicobacter pylori, ulcer disease, sacculation or injury to the lining.
In addition, if there is an injury or disease of the gastrointestinal mucosa, doctors are able to treat it by gastroscopy. Bleeding in particular can be treated by measures such as placing metal clips, rubber bands or injecting anti-bleeding medication. In most cases a gastroscopy is performed to rule out a stomach ulcer, as patients complain of chronic stomach pain before or after eating.
- Recurring heartburn
- Persistent nausea and vomiting
- Swallowing disorders
- Chronic cough
- Pain in the upper abdomen
- Increased flatulence
- Unclear weight loss
- Blood Vomiting
- Blood in stool
- Gastric bleeding
Before a gastroscopy, the patient is prepared for this routine procedure. This preparation includes a detailed explanation of the procedure and information about risks and side effects. At the end of the education, the patient must give his or her consent and document this with a signature.
On the day of the gastroscopy, the patient must fast. Laxative measures are not necessary during this procedure. Should the patient take blood-thinning medication, it must be considered to stop taking it before the gastroscopy examination to avoid complications in the sense of heavy bleeding.
Furthermore, on the day of the gastroscopy, the patient is given a venous access into a vein, usually of the arm, on the day of the examination. Liquid should be given over it before the procedure to avoid drying out the fasting patient (this makes sense especially if the examination is not performed until noon). A gastroscopy is usually performed under a short anaesthetic with Propofol.
For this purpose, a small amount of the anesthetic Propofol is usually injected via the venous access. Throughout the entire duration of the gastroscopy, oxygen saturation, breathing and heart rate are monitored on a monitor, so that therapeutic steps can be taken quickly if vital signs deteriorate. During a gastroscopy, the patient is usually examined lying on his left side.
Before this, a small rigid tube is placed between the teeth. This tube is fixed behind the head with a rubber band. This ensures access to the mouth and throat area, regardless of whether the patient is under anesthesia or not.
The examination instrument (gastroscope) is inserted through this tube into the mouth and throat. The patient is not completely asleep and can react to simple, loud commands. The patient is asked to swallow as soon as the gastroscope passes the throat at the level of the larynx.
If the patient swallows, the epiglottis closes the trachea and allows the gastroscope to enter the esophagus. At the tip of the examination device there is a very bright light, an opening through which air can be introduced into the esophagus and stomach, and an opening through which samples can be taken from the tissue of the upper digestive tract using small forceps and other instruments. Instruments can also be inserted through this opening, which can stop any bleeding.
When inserting the gastroscope, air is first introduced into the oesophagus to unfold the otherwise flaccid structure and allow a clear view. The very strong light at the tip of the gastroscope allows a view of the otherwise dark upper digestive tract. The gastroscope is first maneuvered forward.
The actual inspection is not yet performed here. With a small control on the handle of the gastroscope, the tip of the device can be bent up to 180 degrees. This is the only way to ensure that even hidden areas can be inspected.In contrast to a colonoscopy, the advancement of the examination instrument is quite simple and takes only a few minutes.
As soon as the tip of the gastroscope has reached the stomach, the actual examination begins. The examination consists of three steps:
- Inspection: in all diagnostic gastroscopy, inspection is the most important part. Both the stomach and the esophagus are examined.
In particular, the mucous membrane is examined and assessed to determine whether it is reddened or inflamed, whether there are sources of bleeding (both fresh, possibly injecting bleeding and non-acute bleeding with older blood deposits) or whether there are unnatural constrictions in the esophagus and stomach. The stomach is also examined for stomach ulcers or conspicuous tumors in the stomach lining. When retracting the gastroscope, the oesophagus is also examined.
Here, in addition to bleeding, inflammation and redness, attention is also paid to so-called thrush (fungal infection of the esophagus) and varicose veins (varices), which are very dangerous and can be indications of a bypass circulation in the case of liver damage.
- Biopsies: Small skin samples are taken from conspicuous areas of the mucous membrane of the stomach in order to have them examined in the laboratory for a corresponding malignancy. For this purpose, a small pair of forceps is inserted from the outside through the gastroscope and advanced to the tip of the examination device. The forceps is placed on the suspect area and the skin biopsy is taken and pulled outside.
- Therapeutic procedure: In addition to the diagnosis of a gastroscopy, there is also the possibility to act therapeutically in the same session.
Especially in case of acute and injecting bleeding, which is seen in the esophagus or stomach, it is necessary to stop it with the gastroscope. In most cases, this can be done with a clip, which is inserted from the outside over the examination device and closes the bleeding vessel. Furthermore, the vessel can also be closed by an injection.
In most cases, the examination does not take more than a few minutes.
The procedure of a gastroscopy is painless, but is often described as unpleasant. The examination can be performed while the patient is awake. Before the beginning, the throat can be anaesthetized with a spray or, if the patient wishes, sedatives (usually midazolam or diazepam) can be administered.
These make the patient sleepy, so that he/she is not consciously aware of the procedure, but can still react to simple instructions. During the examination, the patient is positioned on the left side and a mouthpiece is inserted to prevent access to the throat area from being blocked by possible clenching of the teeth. The examination instrument (gastroscope) is an optical device, which is made of plastic and is tubular.
It is very flexible in the guide and contains an opening at the end with a small camera and light source to gain good insight and to transfer the recorded images to a monitor. It also contains a channel through which instruments such as forceps or slings are inserted during the examination and a channel through which air can be introduced. The esophagus, stomach and duodenum are examined.
The endoscope is slowly inserted through the patient’s mouth towards the throat. As the endoscope passes the throat, the examiner asks the patient to swallow hard. During the swallowing process, the larynx closes the trachea and thus prepares a free path through the esophagus.
Under visible control, the examiner pushes the tube downwards in small steps, past the lower sphincter of the esophagus, into the stomach. From there, the tube is advanced further via the so-called stomach gate (pylorus) into the duodenum. Once the deepest point has been reached, air is introduced through the endoscope in order to tighten the flaccid nature of the organs and thus gain a better view of the mucous membrane.
The endoscope is then gradually returned to its original position. If, during the examination, conspicuous areas are detected that show changes in the mucosa, a tissue sample can be taken directly using forceps and then sent to the pathology department for further examination. In addition, possible bleeding can also be stopped during the examination with the endoscope, by attaching a metal clip or by injecting medication.If the examiner detects conspicuous areas in the mucous membrane during the gastroscopy, he can take a small sample of the tissue with the help of a pair of forceps inserted through the endoscope.
The physician covers the affected area with the forceps and uses the tip of the forceps to snap a section out of the mucosa. The tissue can then be transported to the outside via the endoscope. The sample is then sent to a specialized laboratory (pathology), where it is further examined.
The specialist prepares small, thin layers from the sample that is sent in, which are stained with special staining agents. The nature and structure of the tissue is then assessed under the microscope. Special attention is paid to the surface structure.
One looks to see whether the mucous membrane is swollen edematous, whether inflammatory processes or also unevenness or defects can be recognized. In addition, it is assessed whether there are any conspicuous cell clusters that can be distinguished from the remaining tissue and possibly indicate new formations, such as a tumorous change. The tissue sample sent in can be examined for any pathogens that may be present and cause disease.
A gastroscopy can be performed completely without anesthesia, with mild anesthesia, sedation or under a short anaesthesia. Which method is used depends entirely on the patient, his anxiety and physical condition. If the patient does not wish to have an anesthesia for gastroscopy, the throat is anesthetized to perform the diagnosis.
For this purpose, a spray is sprayed into the throat area via the mouth, which numbs the mucous membranes. This allows the patient to hardly or not at all feel the tube and suppresses the gag reflex. There is also the possibility that the patient is given a sedative in addition to the anaesthetic for the throat, for easy relaxation and relief of anxiety (e.g. midazolam or diazepam).
If the gastroscopy is to be performed under anaesthesia, the patient will first of all be given a peripheral vein access, preferably into a vein of the forearm. The patient is administered the anesthetic, usually propofol, through this access. During the entire examination, which the patient is under anesthesia, an employee monitors the patient’s vital signs, i.e. pulse, blood pressure, respiration, oxygen saturation and heart activity via ECG.
When performing gastroscopy under anesthesia, it should be remembered that there are some general risks associated with anesthesia and that not everyone is suitable for anesthesia, e.g. due to allergies. Before the anaesthesia, all factors should be discussed in detail with the anaesthetist. It must also be remembered that the ability to react is limited for some time after the anaesthesia, and therefore one should not drive for 24 hours after the anaesthesia in order not to endanger oneself and others.