Endoscopy is a procedure performed through the mouth that enables the Doctor to see inside your upper gastro-intestinal tract—your oesophagus, stomach and duodenum. Unlike x-rays, which take photographs of these areas, endoscopy lets the Doctor see the surface of these areas directly and provide fare more detail and accuracy than an x-ray.

NIL BY MOUTH AFTER MIDNIGHT.

Your stomach must be empty so do not eat anything for 8 hours before the endoscopy. Small amounts of water can be taken up until 4 hours before the endoscopy. If you must take prescription medication, this can be done up until 2 hours before the endoscopy with a sip of water. Please tell the Doctor if you have had any allergies or bad reactions to medications. The procedure is quite safe during pregnancy and while breast feeding, although you must inform the Doctor if this applies to you.

IF you develop a cold or significant respiratory illness in the lead-up to your procedure you should wait until fully recovered as this increases the risk of sedation, especially if you are asthmatic. If in doubt, contact Dr Holt’s office.

You will be given medication by injection through a vein to make you sleepy and relaxed. The procedure can be performed without sedation if requested. You will probably have little memory of this procedure afterwards. While in a comfortable position on your left side, the Doctor will pass the endoscopy through your mouth and down the throat. The endoscope itself is a plastic tube about as thick as a ball point pen. The instrument will not interfere with your breathing nor cause pain. The examination takes about 20 minutes and normally involves examination of the throat (oesophagus), stomach, and the start of the small bowel (duodenum).

  1. Often a biopsy is performed to take samples of any abnormal areas within the stomach, oesophagus or duodenum. This is a very safe procedure. Very rarely, there can be bleeding.

  2. If you have gastro-oesophageal reflux, you may have a condition called Barrett’s oesophagus which is abnormal tissue within the oesophagus. If we do find this, biopsies are taken. This helps identify if any abnormal cells (dysplasia) are present.

  3. Polyps can occur in the stomach. Most polyps are benign. Very rarely do these polyps develop into malignancy. Some polyps may not need to be removed if they are clearly of a type of polyp known as cystic fundic polyps. Other polyps, however, may require removal with a snare placed around the polyp and removed with diathermy. Rarely there can be a risk of bleeding or perforation following the polypectomy.

  4. If you have problems swallowing food, you may have a stricture or narrowing of the oesophagus. This can require dilation. During the endoscopy, a special dilator is passed through the narrowing to stretch this area. This will then improve your swallowing. This is a safe procedure but there can be a risk of bleeding or discomfort or rarely, perforation. If you do have a dilation performed, you may require a soft diet following this procedure for 24 hours.

  5. If bleeding is identified at endoscopy, this may require therapy with an injection, the use of a diathermy (gold probe), or metal clips to stop the bleeding.

An upper endoscopy is a very accurate way to assess problems within the oesophagus, stomach and top of the small bowel and duodenum. Rarely, lesions can be missed especially if they are found on the outside of the stomach.

Barium Swallow and Meal

This involves a barium x-rays examination which looks at the lining of the oesophagus, stomach and duodenum. Is it not as accurate as an upper endoscopy as it cannot detect Barrett’s oesophagus or changes within the stomach lining, in particular, whether there is an infection. No biopsies can be performed. If the barium shows an abnormality, then often you will need to proceed to an upper endoscopy. Barium meal can be useful if you have problems with food sticking in your gullet (dysphagia) prior to endoscopy.

Ultrasound

This is normally only useful for assessing the gallbladder, liver and spleen and does not give a good visualisation of the stomach.

Capsule Endoscopy

This is a capsule camera that is swallowed. Very limited views are obtained of the oesophagus and stomach. It is predominately used for assessing the small intestine.

CT Scan

This is useful if there are problems outside the stomach or to assess for thickening of the stomach lining, however, biopsies are not able to be performed with this technique.

Bleeding

This is a rare complication following upper endoscopy and biopsy. There is a slightly higher risk of this occurring if you require oesophageal dilation or polypectomy.

Perforation (Hole in the Gut Wall)

Damage to the oesophagus and stomach very rarely occurs with a routine endoscopy (1:50,000 normal upper endoscopies). There is a rare higher risk if there is a narrowing of the oesophagus. The risk of perforation with a tight stricture is approximately 1:500. This life threatening complication will require a prolonged hospital stay and usually an operation.

Reaction to Anaesthetic

The following symptoms may be present following anaesthetic:

  • Pain in the arm at the injection site
  • Bruising or infection where the cannula is inserted
  • Nausea and vomiting
  • Altered heart rate
  • Dizziness or fainting
  • Allergic reaction
  • Aspiration of vomit from the stomach into the lungs
  • Heart attack
  • Stroke and death (extremely rare)

Other Injury

Injury to lips, mouth, teeth or dental work rarely can occur.

You will remain in the recovery area for about 30-60 minutes until the main effects of any medication wear off. Your throat may feel numb and slightly sore. You should not attempt to eat or drink until your swallowing reflex is normal. After this, you may return to your regular diet unless otherwise instructed. You may feel slightly bloated due to the air that has been injected through the endoscope. This will pass quickly.

Dr Holt will discuss the findings with you after you have recovered from the procedure. You may not remember all the details of the discussion due to a residual effect of the medication, so it is important you arrange a follow-up appointment with either your referring Doctor or Dr Holt to discuss the results. Occasionally, you can get some mild heartburn after the procedure which normally will settle with antacids. If you have cramping, then peppermint tea of Colofac may help.

It is important that you contact Dr Holt, your local GP or major Accident and Emergency Department if you have severe pain, fevers or passage of blood or black bowel motions following the procedure.

IMPORTANT

  1. A responsible adult must be able to drive you home and should remain with you until you fully recover for 12 hours at home. It is not safe for you to use public transport or use a taxi on your own. If you do require a taxi, then a companion should accompany you.

  2. For the remainder of the day, you should not drive a car, operate machinery or make important decisions as sedation impairs your reflexes.

  3. Occasionally, some patients may have diminished memory for one day following the procedure.