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Gastroscopy

The esophagogastroduodenoscopy is a medical diagnostic procedure used in internal medicine to view the upper part of the gastrointestinal tract. This non-invasive procedure is used for many complaints and requires little to no time for recovery from the procedure.

Reasons for the Procedure

Patients present to their physician with physical complaints. For example, a patient may come into the office and say they have been feeling tired and forgetful. Through many tests and evaluations, the physician may come to the conclusion that the patient is low on blood or anemic. Since the physician cannot see where the patient is losing the blood from the outside, they use scopes put through an already existing opening to see inside. In this case, the physician would explore the upper gastrointestinal tract with an endoscope to see if the patient has a bleed. This would be the first example of when the procedure might be used. Other examples of reasons for the procedure diagnostically would include:

Chronic indigestion or heartburn in older patients
Difficulty swallowing
Painful swallowing
Chronic vomiting of blood or clots

Endoscopy may also be used in instances of viewing existing diagnosed illnesses in a surveillance role. If a patient is diagnosed with lesions, ulcers or abnormal cells then it is important to measure the growth of those questionable areas. This could determine whether the patient needs more aggressive treatment. Other examples of the procedure in a surveillance role would include:

To view area after surgery
To view Barrett’s Esophagus (damage from chronic heartburn)
There are many therapies that are performed through endoscopy. Some are repeated therapies and some are a one-time procedure with a wide range of uses.
Examples of the procedure in a therapeutic role would include:
Place bands on enlarged esophageal veins called varicies
Inject epinephrine in bleeding lesions
Removal of foreign objects
Cauterize or burn tissues that are bleeding
Place a balloon or block off a bleeding esophageal artery
Photodynamic therapy (light treatment for lesions)
Drain a pancreatic pseudocyst
Correcting stenosis by dilating esophagus
Adjust the lower esophageal sphincter to retain stomach acids
Place a feeding tube that bypasses the stomach
Place a stomach band

Procedure

Once a patient has been deemed beneficial of the procedure, a time is scheduled if not on an emergency basis. The patient will be instructed to not eat or drink anything for at least 4-6 hours before the appointment. The physician would not get a good picture inside the area if there is food present. It is also very dangerous for a patient to vomit during this procedure since they do not have full control of their airway with the equipment in it.

The procedure is not typically painful as it is uncomfortable for the patient. The physician will administer a lidocaine spray in the patient’s oropharynx. This will lower the patient’s gag reflex and will reduce the patient’s reaction to the scope. Because this procedure does induce anxiety to the patient, if the patient is unable to remain still and calm then a general anesthesia may be considered. Perforation and bleeding are the biggest risks during the procedure and patient movement increases those risks.

Once the patient is ready for the procedure, the physician will have the patient lie on their left side with the head slightly elevated a straight line. To prevent the patient from biting down on the scope, a mouth guard is placed in the patient’s mouth. The endoscope is introduced through the mouth, over the tongue, and into the esophagus. The lidocaine spray should prevent the patient from gagging at this point. After inspection of that area, the scope is passed through the stomach and the first and second parts of the duodenum. At this point, the scope is retracted in a slow methodical way that gives the examiner different views of each area of the tract. If a biopsy is needed, small samples can be taken with the end of the scope. The air in the stomach is then removed before the scope. All visual findings are recorded either will still images or video. These will be reviewed by the physician, specialists and patient before being added to the permanent medical record.

Image Caption: Esophageal ulcers after banding, posted in public domain with permission of patient. Credit: Samir/Wikipedia

Gastroscopy


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