After a careful medical assessment, your doctor has recommended that you should have a gastroscopy examination, a non-surgical technique that can aid in diagnosing problems of the upper digestive system. Based on the results of this exam, your doctor can then suggest the best course of treatment for your problem. More accurate than a barium x-ray and much simpler than exploratory surgery, gastroscopy is a safe and highly effective diagnostic technique.

Understandably, most patients are a bit apprehensive about the idea of "swallowing a scope." However, with the help of modern medical instruments and sedation, patients usually tolerate this test with ease. After the test is completed, most patients are pleasantly surprised by how easy it was. We have written this information to answer any questions that you may have about gastroscopy. If you have additional questions or concerns after reading it, please feel free to consult your doctor.

REASONS FOR THE EXAM

Disorders of the upper digestive tract are quite common in our stressful society. Various factors such as diet, environment, and heredity contribute to these conditions. Gastroscopy is often useful in diagnosing and treating problems such as:

• Abdominal pain
• Bleeding from the digestive tract
• Cancers of the stomach or esophagus
• Chronic heartburn and indigestion
• Diagnosis and removal of stomach polyps
• Dilatation of esophageal strictures
• Gastritis, or stomach inflammation
• Hiatal hernia
• Removal of swallowed objects
• Trouble swallowing
• Treatment of the "Ulcer Bacteria"
• Ulcers of the esophagus
• Ulcers of the stomach and ulcers of the duodenum
• Unexplained chest pain

Your cooperation is essential for a successful examination. There are certain things that you can do before the test to help:

Preparation

Your stomach must be empty during gastroscopy so that your doctor's view is not blocked by particles of food. If your test is scheduled in the morning, you must not eat or drink anything after midnight the night before the test. You may gargle and brush your teeth in the morning.

If your test is scheduled in the afternoon, you may have only liquids - such as juice, coffee, tea, broth - for breakfast. Then begin fasting. You should not eat or drink anything for at least 6 hours before the exam.

Medications

You may continue to take any important medications that your personal physician has prescribed - even on the morning of the test. Simply take them with a small sip of water at least two hours before your appointment. This allows time for the tablets to dissolve completely. You should not take any antacids on the day of the test. If you are a diabetic on insulin, call for special instructions. Do not use tobacco within two hours of your test since this tends to affect the natural color of your stomach lining.

What To Wear

You will have to change into a patient gown before the examination. If this test is being done on an outpatient basis, you should wear loose, comfortable, casual clothing that is easily removed and folded. Avoid girdles, pantyhose, or tight-fitting garments. Please leave your jewlery, valuables, and high heels at home.

Transportation

To minimize any discomfort, you will receive a sedative injection before the examination. As this medication will make you drowsy for several hours, you cannot safely drive a car for the remainder of the day. Therefore, if this test is being done on an outpatient basis, a family member or friend must accompany you to the office in order to drive you home. If possible, you should choose someone with whom the doctor can freely discuss the results of your test. We request that your companion remain in the office during the test. You should plan to arrive fifteen minutes before your appointment and to stay approximately two hours.

Of course, if this test is being done on a hospital inpatient basis, a driver will not be needed. After the examination, you will simply return to your hospital bed to sleep off the remainder of the medication.

Your Permission

If you have any questions about this test, do not hesitate to ask the GI Assistant, nurse, or doctor. To signify that you completely understand what this test involves, you will be asked to sign a written consent form, or "permit," before the test begins.

LOOKING INSIDE...

Before the test begins, you will be asked to remove any dentures or eyeglasses. Contact lenses need not be removed.

To make this examination more comfortable, the GI Assistant will then spray the back of your throat with a liquid anesthetic. This may taste slightly bitter and will produce a numbness in your mouth and throat. This effect will last approximately one half hour. Then you will be positioned comfortably on your left side on the padded examination table. A small painless oximeter probe will be placed on your fingertip to monitor your pulse rate and breathing function during the exam.

To maximize your comfort during the examination, you will then be given an intravenous injection of Demerol, a pain killer, combined with Versed, a mild tranquilizer. If you are allergic to either of these medications, please inform your doctor. These medications will make you drowsy and relaxed. You will not be deep asleep like a general anesthetic, but your doctor will give you sufficient medication to induce a pleasant "twilight sleep." In this manner, you should feel no discomfort during the test. Upon awakening, you will probably have little recollection of the procedure, itself. Once you are very relaxed, the doctor will gently insert the flexible gastroscope. Since this scope does not enter your "windpipe," it will not interfere with your ability to breathe. The most frequent fear expressed by patients is that they will be unable to swallow the scope because of gagging. Fortunately, the medications given prior to the procedure usually prevent this from happening. Even the most apprehensive patients tolerate the procedure quite well.

A small mouthpiece will then be placed between your teeth enabling you to relax your jaws. To better see the lining of your upper digestive tract, your stomach is then gently filled with a small quantity of air. While this air may cause the sensation of abdominal fullness, it should not be painful. Your doctor can now begin to inspect the lining of your esophagus, stomach, and duodenum, an exam that takes about fifteen minutes.

TAKING SPECIMENS

If your gastroscopy reveals any abnormal condition such as an ulcer, your doctor may photograph it. This picture provides a permanent record for your medical chart and also enables your other doctors to see what is wrong. If necessary, a videotape of the procedure may be recorded for later review.

To better evaluate areas of abnormality, your doctor may take a biopsy. This procedure is performed painlessly with a miniature forceps. After passing the forceps through a hollow channel inside the gastroscope, your doctor simply snips off a tiny sample of tissue for laboratory analysis. If a small growth called a polyp is found, it can often be removed for analysis. This is done by using a thin wire-loop snare which cuts off the polyp and then cauterizes the base using electric heat. This is also painless.

Be assured that your doctor's decision to take a biopsy does not necessarily mean that cancer is suspected. Biopsies of the digestive tract are routinely taken to investigate other problems such as inflammation and ulcers.

If you have difficulty swallowing and the doctor finds a narrowed area in your esophagus, it may be possible to dilate this "stricture" during this exam with a small balloon dilator.

AFTER THE TEST

After an outpatient gastroscopy, you will rest awhile in the office recovery room. Your companion will be asked to sit with you while the effects of the sedation wear off. Initially you may feel slightly bloated from the air that was placed in your stomach during the examination. This feeling will gradually subside. Once you are more alert, the doctor will meet with you to discuss the test's findings as well as any recommended treatment. If a biopsy was obtained, the doctor will contact you with the results when they become available.

You will then be able to return home with your companion's assistance. Since you will still be somewhat drowsy and uncoordinated, you will be taken in a wheelchair to your car by the office personnel.

Since the effects of the sedatives may take up to 24 hours to wear off completely, you should plan to go directly home - not to a restaurant. Have a light meal, and rest for several hours. After the sedation has completely worn off, you may resume your normal diet. However, you will not be able to go to work, drive your car, or operate any dangerous machinery for the remainder of the day. You may experience a mild sore throat after gastroscopy. If this occurs, anesthetic throat lozenges, such as Cepacol or Sucrets, are helpful.

IS THIS TEST DANGEROUS ?

While every medical procedure involves some degree of risk, the frequency of complications during gastroscopy is extremely low. With the modern flexible fiberoptic instruments now available, gastroscopy has become a safe and simple method of examining the upper digestive tract. When performed by a physician who is specially trained and experienced in this procedure, the benefits of gastroscopy far exceed its risks.

Your doctor is a GASTROENTEROLOGIST. In addition to standard medical training, he has received special instruction in diseases of the digestive system and has been thoroughly trained in the safe and proper operation of the gastroscope. The combination of this experience and your cooperation should make this test as safe and simple as possible. However, as with all medical procedures, complications can sometimes occur.

The main risks are perforation, or a tear, of the stomach or esophagus lining and bleeding. Although perforation generally requires surgery, certain cases may be treated with antibiotics and intravenous fluids. Bleeding may occur at the site of a biopsy or polyp removal. Typically minor in degree, such bleeding may simply stop on its own or be controlled by cauterization. Seldom does surgery become necessary. Fortunately, both perforation and bleeding are extremely rare during gastroscopy. Other minor risks include drug reactions and complications related to other diseases you may have. Consequently, you should inform your doctor of all allergic tendencies and medical problems. Occasionally, the site of the sedative injection may become inflamed and tender for a short time. This is usually not serious and warm compresses for a few days are usually helpful. While any of these complications may possibly occur, it is well to remember that each of them occurs quite infrequently. Your doctor can further discuss the above risks with you with regard to your particular need for gastroscopy.

HOW ABOUT AIDS ?

Due to the recent extensive coverage of AIDS in the media, some individuals have been concerned that they might contract AIDS through this examination. Be assured that this is not the case. All our instruments are extensively cleaned and undergo high level disinfection between each case. Only techniques known to kill all disease-causing bacteria and viruses including the AIDS virus are employed in this process.

A VALUABLE TOOL...

In summary, gastroscopy is a valuable tool for the diagnosis and treatment of diseases of the upper digestive tract. Abnormalities suspected by X-ray can be confirmed and studied in detail during this procedure. Even when X-rays are normal, the cause of such symptoms as abdominal pain and internal bleeding can often be determined by gastroscopy. This technique is useful in the diagnosis and follow-up of patients with peptic ulcers and also allows dilatation of esophageal strictures. Gastroscopy is an extremely safe and worthwhile procedure that is very well tolerated. If you have any questions or concerns regarding this procedure, do not hesitate to consult your doctor.