Gastroscopy is a simple procedure that involves a flexible camera being inserted into your mouth for a high-resolution assessment of your throat, oesophagus, stomach, duodenum, and small intestine. Most patients prefer to have some sedation for this procedure to reduce the gag reflex and to go to sleep. The procedure itself is very simple and only takes a few minutes. Therefore it can also be done under local sedation to numb your throat, but to stay awake. This has the advantage that you can still drive and work the same day after the procedure. If you opt for sedation you are not allowed to drive or make important decisions after your procedure and you need someone to collect you afterwards.
A lot of information is obtained during a gastroscopy that can not be found on blood test, xrays, CT or MRI scans. During your gastroscopy you will be assessed for:
1. Throat and vocal cords
Reflux can lead to redness and swelling of the vocal cords. The area before the vocal cords (cricopharynx) is well seen during gastroscopy. However, if all of your symptoms originate in your throat an assessment by an Ear Nose and Throat doctor could be more useful, as they use a smaller camera that can also assess the nose, sinuses and throat in more detail.
2. Oesophagus (food pipe)
A feeling of a lump in the throat also called a globus sensation is very common. Most of the time no cause is found on gastroscopy as the irritation is too small or it is a muscular problem being less efficient to swallow tablets for instance. However, sometimes this feeling is caused by a gastric inlet patch. This is a small area of stomach-like lining after the vocal cords in the oesophagus itself. This is commonly seen and is not precancerous, but can be treated if symptoms are severe.
If you have difficulty swallowing this could be due to a food allergy called "eosinophilic oesophagitis". These are the same immune cells that cause asthma and hay fever. This results in the oesophagus having a rippled effect which can catch food or make it difficult to pass into the stomach.
Reflux symptoms are very common in the general population. This can be due to a small hiatus hernia, where the stomach has slipped upwards into the chest or a weak valve at the junction between the stomach and the oesophagus. Ideally, if you are having a gastroscopy for reflux symptoms, stopping any anti-acid medications prior to the gastroscopy can be beneficial.
Chronic reflux can lead to a change of lining in your oesophagus to a stomach type lining called Barrett's oesophagus. This is a risk factor for developing cancers although most frequently this just needs monitoring every few years and gtreatment with an anti-acid like omeprazole.
Up to 30% of the population have a stomach infection called Helicobacter. This can lead to pain, heartburn, ulcers and even cancers. We can detect this infection with 3 different sorts of biopsy; 1) bedside CLO test 2) histology and 3) helicobacter culture. Curing this stomach infection may make you feel much better and prevent cancers in the future. After washing the surface clean the stomach is inspected looking forward as well as during retroflexion where I point the camera backwards. Ulcers, cancers inflammation and precancerous changes in the lining (metaplasia can be detected).
The stomach is designed to withstand acid, but often the first part of the duodenum can be irritated by acid before it is neutralised. I can also measure your digestive enzyme called disaccharides to determine if you are intolerant to dairy or sugars. A duodenal biopsy is the gold standard test to look for coeliac disease.