Gastroscopy

A gastroscopy, also known as an upper gastrointestinal endoscopy, allows the mucosa of the oesophagus, stomach and duodenum to be viewed directly using a flexible tube fitted with a camera. It can be used to investigate symptoms or bleeding, examine abnormalities detected in other tests, take biopsies, monitor certain conditions and carry out some endoscopic treatments.

What is a gastroscopy and what does it allow us to examine?

A gastroscopy is carried out using a flexible instrument called an endoscope, which is inserted through the mouth and guided down through the throat and oesophagus into the stomach and the first part of the duodenum. The camera at the tip of the endoscope allows the inner surface of these organs to be viewed directly.

The endoscope also has a channel through which instruments can be inserted to take biopsies, control certain types of bleeding, remove foreign bodies, dilate narrowings or treat selected lesions.

The test provides a direct view of the mucosa, but it does not detect all diseases. Its usefulness depends on an appropriate indication, good visibility, and the successful collection of the necessary samples when indicated.

When might a gastroscopy be recommended?

It may be requested to investigate difficulty or pain when swallowing, gastrointestinal bleeding, iron-deficiency anaemia in certain situations, persistent vomiting, unexplained weight loss, or abnormalities observed in laboratory tests or imaging studies.

It may also be used in cases of persistent upper gastrointestinal symptoms where there are signs or a history that suggest the mucosa should be examined directly.

Not everyone with heartburn, acid reflux, upper abdominal pain, nausea or indigestion needs a gastroscopy. Whether it is indicated depends on the overall presentation of symptoms, their progression, the patient’s age, medical history and the results of other tests carried out.

Investigation of gastrointestinal bleeding

Where there is a possible upper gastrointestinal haemorrhage, a gastroscopy can help to locate its source and, in certain cases, treat it during the examination itself. The patient’s overall clinical condition is always assessed alongside the endoscopy and may require further measures before or after the procedure.

Monitoring of certain conditions

Some people with Barrett’s oesophagus, atrophic changes or intestinal metaplasia may require endoscopic follow-up. The frequency of these checks depends on the extent of the changes, the results of the biopsies and the individual’s risk.

Biopsies and treatments during a gastroscopy

Biopsies are small samples of tissue which are subsequently examined under a microscope. They can be taken from a visible lesion or from areas that appear normal. Some microscopic conditions, such as coeliac disease or eosinophilic oesophagitis, may require biopsies even if no obvious abnormality is found during the examination.

The samples can also be used to investigate inflammation, atrophic gastritis, intestinal metaplasia, Barrett’s oesophagus, Helicobacter pylori infection or certain suspicious lesions.

Not all gastroscopies require biopsies, and a sample does not always provide a conclusive answer. Their usefulness depends on obtaining sufficient tissue from the correct area.

During gastroscopy, it is also possible to treat certain bleeds, remove foreign bodies, dilate some strictures or treat superficial lesions. More complex procedures may require a scheduled endoscopic procedure.

How to prepare for a gastroscopy

Your stomach must be sufficiently empty to allow for a clear view of the lining and to reduce the risk of its contents entering the airways. The Digestive Endoscopy Unit will provide specific instructions regarding food, liquids and medication.

Solid foods usually require a longer fasting period than certain liquids, but there is no single guideline that applies to everyone.

The schedule may vary depending on the time of the examination, the planned sedation, any pre-existing conditions and the type of procedure to be carried out. You must follow the guidelines provided by the unit and must not extend or alter the fasting period on your own initiative.

Medicines and medical history that must be disclosed

Before a gastroscopy, it is important to provide information on:

• Anticoagulants and antiplatelet agents.

• Insulin and other treatments for diabetes.

• Medicines that may delay gastric emptying.

• Respiratory, cardiac, renal or neurological conditions.

• Pregnancy or the possibility of pregnancy.

• Allergies.

• Dental prostheses or removable dentures.

• Previous digestive surgery.

• Significant difficulty swallowing.

• History of aspiration.

• Previous reactions to sedatives or anaesthetics.

Anticoagulants, antiplatelet agents, antidiabetic drugs and other treatments must not be discontinued without specific medical advice. Management depends on the medication and whether a diagnostic examination, biopsy or a procedure with an increased risk of bleeding is planned.

Sedation during gastroscopy and the need for a companion

A gastroscopy can be carried out using a local anaesthetic in the throat, under sedation or, in certain situations, without any sedation.

Sedation helps to reduce anxiety, gagging, discomfort and memories of the procedure, although it does not guarantee that everyone will remain completely asleep or that all sensations will disappear.

During administration, breathing, pulse, blood pressure and oxygen levels are monitored.

When sedation is used, it is usually necessary to be accompanied to the appointment and to subsequently follow the recommended restrictions regarding driving, operating machinery, consuming alcohol or carrying out activities that require full attention

How a gastroscopy is performed

Before the procedure begins, the team checks the reason for the examination, whether the patient has fasted, their medication, any allergies and any relevant medical history. Removable dentures must be taken out and a mouth guard is usually fitted to protect the teeth and the endoscope.

The patient usually lies on their left side. The endoscope is inserted through the mouth and advanced through the throat and oesophagus into the stomach and duodenum.

The instrument does not obstruct the entire airway, although its passage may cause gagging, pressure or a sensation of a foreign body. Air or carbon dioxide is introduced to distend the walls so that the mucosa can be examined. Saliva, foam, mucus, blood or retained contents may also be suctioned out.

The specialist systematically examines the various areas and, where indicated, takes biopsies or carries out treatment. Occasionally, the examination may be limited by food residues, heavy bleeding, a narrowing, abnormal anatomy or safety considerations.

What you might feel during a gastroscopy and what the recovery is like

During the examination, you may experience retching, pressure in the throat, nausea, increased salivation, a sensation of a foreign body, or the urge to burp. The gas used to distend the stomach may cause a feeling of fullness or bloating.

Sedation can significantly reduce these sensations, although the experience varies from person to person. The taking of small biopsies from the lining is usually imperceptible. However, you may feel other movements associated with the endoscope.

After the procedure, you may experience mild throat irritation, temporary hoarseness, flatulence, bloating, nausea, tiredness or drowsiness.

If a local anaesthetic has been used in your throat, the team will tell you when you can drink or eat again. Specific instructions may be required following certain endoscopic procedures.

When are the full results of a gastroscopy available?

At the end of the examination, the specialist is usually able to explain the visible findings and confirm whether the procedure has been completed. Where biopsies are taken, the definitive interpretation of these samples follows later, after the histopathological examination.

A sample may be insufficient, too superficial or fail to represent the full extent of the abnormality. If the laboratory result does not match the endoscopic findings or the clinical suspicion, further investigations or new biopsies may be necessary.

Limitations of gastroscopy

The usefulness of the test depends on the quality of the visualisation, the areas examined and the biopsies taken where necessary. Gastroscopy may fail to detect small or very subtle lesions, particularly when these are obscured by blood, foam or food debris.

It primarily examines the inner surface of the oesophagus, the stomach and the proximal duodenum. It does not fully examine the deeper layers of the wall or neighbouring organs. A visual examination showing no abnormalities does not rule out microscopic diseases if appropriate samples have not been taken.

Image enhancement techniques can improve the characterisation of certain lesions, but they do not replace a systematic examination nor do they eliminate the possibility of a finding being overlooked.

Risks and possible complications of a gastroscopy

The risk profile depends on your state of health, the sedation used and the procedures carried out. The most common side effects include a sore throat, flatulence, bloating, nausea, drowsiness and minor discomfort at the site where an intravenous line has been inserted.

Sedation may cause respiratory disturbances, a drop in oxygen levels, changes in blood pressure, heart rhythm disturbances or reactions to the medication. Bleeding is uncommon following simple diagnostic biopsies, but the risk may increase when resections, dilations or other treatments are carried out.

Perforation is a hole in the wall of the digestive tract. It is rare, but may require endoscopic treatment, antibiotics, hospital admission or surgery. Aspiration of gastric contents may also occur and, less frequently, dental or throat injuries.

When to seek medical advice following a gastroscopy

You should seek medical advice if you experience:

• Severe or worsening pain in the chest or abdomen.

• Difficulty breathing.

• Fever.

• Persistent or bloody vomiting.

• Large amounts of black stools or unexpected bleeding.

• Increasing difficulty swallowing.

• Severe dizziness or fainting.

• Severely distended abdomen.

• General deterioration.

A slight sore throat or some bloating may occur after the test. The severity and progression of the symptoms help to distinguish these common discomforts from a possible complication.

Gastroscopy in special circumstances

People with diabetes or delayed gastric emptying may require specific instructions regarding fasting, timing and treatment.

Certain respiratory or cardiac conditions may require adjustments to the sedation and monitoring strategy. During pregnancy, the indication, timing of the examination and the medicines used are determined on a case-by-case basis.

Previous gastrointestinal surgery may alter the anatomy and change the way the examination is carried out. In older or frail patients, the decision takes into account the expected benefit, any associated conditions and the risks of the procedure.

Gastroscopy and other digestive tests

The most appropriate test depends on the information the medical team needs to obtain. Breath tests or faecal antigen tests can be used to screen for Helicobacter pylori when there is no other indication for a gastroscopy.

Oesophageal manometry assesses the movement and pressures within the oesophagus, whilst pH and impedance monitoring enable the evaluation of certain reflux problems. Computed tomography (CT) and magnetic resonance imaging (MRI) provide information on the digestive tract wall and neighbouring organs.

Echoendoscopy combines endoscopy and ultrasound to examine the deep layers of the wall and neighbouring structures. These techniques are not equivalent; each addresses a different clinical question.

Gastroscopy specialists at Memorial Publio Cordón

At Memorial Publio Cordón Hospital, gastroscopies are carried out in the Digestive Endoscopy Unit, which forms part of the Gastroenterology department. The unit performs diagnostic and therapeutic gastroscopies, as well as other advanced endoscopic procedures.

The Department of Gastroenterology is headed by Dr Malena García Arredondo, whilst the Digestive Endoscopy Unit is headed by Dr Javier Aranda Hernández and comprises:

• Dr Javier Aranda Hernández

• Dr Marta Cruz Aparicio

• Dr Marta Barceló López

• Dr Ana Isabel Romero Reina

• Dr Malena García Arredondo

When biopsies are taken or lesions are removed, histopathological analysis completes the interpretation of the findings.