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Gastroscopy

Procedures & Conditions Treated

Definition

An upper endoscopy is a procedure used to visually examine your upper digestive system with a tiny camera on the end of a long, flexible tube. A specialist in diseases of the digestive system (gastroenterologist/general surgeon) uses endoscopy to diagnose and, sometimes, treat conditions that affect the esophagus, stomach and beginning of the small intestine (duodenum).

The medical term for an upper endoscopy is esophagogastroduodenoscopy. An upper endoscopy can be done in an outpatient surgery center or a hospital. Oftentimes a hospital has a waiting list and may not have anaesthesiologists to give you sedation. An endoscopist at the hospital may give you lighter sedation.

Why it’s done

An upper endoscopy is used to diagnose and, sometimes, treat conditions that affect the upper part of your digestive system, including the esophagus, stomach and beginning of the small intestine (duodenum).

Your doctor may recommend an endoscopy procedure to:

  • Investigate symptoms. Endoscopy may help your doctor determine what’s causing digestive signs and symptoms, such as nausea, vomiting, abdominal pain, difficulty swallowing and gastrointestinal bleeding.
  • Diagnose. Your doctor may use endoscopy to collect tissue samples (biopsy) to test for diseases and conditions such as anemia, bleeding, inflammation, diarrhea or cancers of the digestive system.
  • Treat. Your doctor can pass special tools through the endoscope to treat problems in your digestive system.

Risks

Endoscopy is a very safe procedure. However, it carries a very small risk of complications. Rare complications include:

  • Bleeding. Your risk of bleeding complications after endoscopy is increased if the procedure involves removing a piece of tissue for testing (biopsy) or treating a digestive system problem. In rare cases, such bleeding may require a blood transfusion.
  • Infection. Most endoscopies consist of an examination and biopsy, and risk of infection is low. The risk of infection increases when additional procedures are performed as part of your endoscopy. Most infections are minor and can be treated with antibiotics. Your doctor may give you preventive antibiotics before your procedure if you are at higher risk of infection.
  • Tearing of the gastrointestinal tract. A tear in your esophagus or another part of your upper digestive tract may require hospitalization, and sometimes surgery to repair it. The risk of this complication is very low — it occurs in an estimated 3 to 5 of every 10,000 diagnostic upper endoscopies.

You can reduce your risk of complications by carefully following your doctor’s instructions for preparing for endoscopy, such as fasting and stopping certain medications.

Signs and symptoms that could indicate a complication

Signs and symptoms to watch for after your endoscopy include:

  • Fever
  • Chest pain
  • Shortness of breath
  • Black or very dark colored stool
  • Difficulty swallowing
  • Severe or persistent abdominal pain
  • Vomiting

Call your doctor immediately or go to an emergency room if you experience any of these signs or symptoms.

How do I prepare

Your doctor will give you specific instructions to prepare for your endoscopy. In some cases, your doctor may ask that you:

  • Fast before the endoscopy. You may be asked to stop drinking and eating four to eight hours before your endoscopy to ensure your stomach is empty for the procedure.
  • Stop taking certain medications. You may be asked to stop taking certain blood-thinning medications in the days before your endoscopy. Blood thinners may increase your risk of bleeding if certain procedures are performed during endoscopy. If you have chronic conditions, such as diabetes, heart disease or high blood pressure, your doctor will give you specific instructions regarding your medications.

Tell your doctor about all the medications and supplements you’re taking before your endoscopy.

Can I go back to work or drive?

Most people undergoing an upper endoscopy will receive a sedative to relax them and make them more comfortable during the procedure. If you’ll be sedated during the procedure, plan for your recovery while the sedative wears off. You may feel mentally alert, but your memory, reaction times and judgment may be impaired. Find someone to drive you home. You cannot drive for 24 hours. You may also need to take the day off from work. Don’t make any important personal or financial decisions for 24 hours.

What to expect during the procedure?

During an upper endoscopy procedure, you’ll be asked to lie down on a table on your back or on your side.

Monitors often will be attached to your body to allow your health care team to monitor your breathing, blood pressure and heart rate. You may receive a sedative medication through a vein in your forearm. This medication helps you relax during the endoscopy. Most people don’t feel or remember anything during or after the procedure.

Your doctor may spray an anesthetic in your mouth to numb your throat in preparation for insertion of the long, flexible tube (endoscope). You may be asked to wear a plastic mouth guard to hold your mouth open. Then the endoscope is inserted in your mouth. Your doctor may ask you to swallow as the scope passes down your throat. You may feel some pressure in your throat, but you shouldn’t feel pain.

You can’t talk after the endoscope passes down your throat, though you can make noises. The endoscope doesn’t interfere with your breathing.

As your doctor passes the endoscope down your esophagus, a tiny camera at the tip transmits images to a video monitor in the exam room. Your doctor watches this monitor to look for abnormalities in your upper digestive tract. If abnormalities are found in your digestive tract, your doctor may record images for later examination.

Gentle air pressure may be fed into your esophagus to inflate your digestive tract, so the endoscope can move freely, and the folds of your digestive tract are more easily examined. The air can create a feeling of pressure or fullness.

Your doctor will pass special surgical tools through the endoscope to collect a tissue sample or remove a polyp. Your doctor watches the video monitor to guide the tools.

When your doctor has finished the exam, the endoscope is slowly retracted through your mouth. Endoscopy typically takes five to 20 minutes, depending on your situation.

After endoscopy
You’ll be taken to a recovery area to sit or lie quietly after your endoscopy. You may stay for an hour or so. This allows your health care team to monitor you as the sedative begins to wear off.

Once you’re at home, you may experience some mildly uncomfortable signs and symptoms after endoscopy, such as:

  • Bloating and gas
  • Cramping
  • Sore throat

These signs and symptoms will improve with time. If you’re concerned or quite uncomfortable, call your doctor.

Take it easy for the rest of the day after your endoscopy. You may feel alert, but your reaction times and judgment are delayed after receiving a sedative.

Results

When you receive the results of your endoscopy will depend on your situation. If, for instance, your doctor performed the endoscopy to look for an ulcer, you may learn the findings right after your procedure. If a tissue sample (biopsy) was collected, it may take a few days to get results from the testing laboratory. Ask your doctor when you can expect the results of your endoscopy.

Dr. Ravi Kumar completed his Bachelor of Health Sciences at McMaster University. He then pursued his Medical Doctorate and Urology residency at The University of Ottawa. He subsequently completed a fellowship in Urologic Oncology and Robotic Surgery at the Princess Margaret Cancer Centre at the University of Toronto. During his fellowship, he obtained a Master of Engineering from the Institute of Biomedical Engineering at the University of Toronto. He is the co-lead author of the Canadian Urological Association/American Urological Association guideline on the diagnosis and management of adrenal masses.

Dr. Kumar treats a wide variety of urologic conditions including BPH and kidney stones, with a special focus on delivering cutting-edge care for prostate cancer, kidney cancer and bladder cancer.

Dr. Ashwin Maharaj obtained his undergraduate degree in Biology/Physiology from the University of Western Ontario (BSc). e became certified through is a Diplomate of the American Board of Surgery and was certified as fellow of the American College of Surgeons (FACS) and recently recertified. He is a member of the Canadian Association of General Surgeons. His current clinical interests are devoted to outpatient acute and chronic gastrointestinal medicine/surgery as well as abdominal wall hernia surgery and practices in certified facilities in Toronto. He has research experience in gastrointestinal disease as well as surgical education teaching resident surgeons and medical students.

Dr. Diana Magee completed her undergraduate education at Cornell University followed by a Master of Public Health degree at Boston University. She received her medical degree from Queen’s University and completed her urology residency at the University of Toronto. While in residency she enrolled in the Surgeon Scientist program and completed her Master of Science in Health Services Research. She completed her fellowship in urologic oncology at Fox Chase Cancer Center in Philadelphia. Dr. Magee’s area of expertise is in the management of urologic cancers as well as performing minimally invasive surgery.

Dr. Pianezza completed his medical degree (MD) at the University of Ottawa in 2002. He became a member of the Royal College of Physicians of Canada (FRCSC). He then completed a one-year fellowship in minimally invasive surgery and endourology at the University of Alberta in Edmonton in 2008.

Dr. M. Pianezza has been a staff urologist in Sudbury at the Health Sciences North since January 2010. He was Head of Urology from February 2013 to September 2016. He is an Assistant Professor of Surgery at the Northern Ontario School of Medicine.

Dr. Heimrath completed his medical school at the University of Ottawa, his surgical residency at McGill University, and his Endourology, Minimally Invasive, and Robotics Fellowship at the University of Toronto. Dr. Heimrath’s areas of expertise include the management of complex kidney stones and urologic cancers as well as performing minimally invasive surgery. Since 2016, Dr. Heimrath has worked overseas in Malawi and Rwanda to explore opportunities to build urologic and surgical capacity in the developing world. He is a partner in the Urology Global Surgery initiative at the University of Toronto and holds a lecturer appointment with the University of Toronto.

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Dr. Luke Fazio is the current Chief of Urology at Humber River Hospital. Dr. Fazio received his medical degree from McGill University in 1999. Following this, he finished his Endourology and Minimally Invasive fellowship at the University of Toronto. As the Urology Medical Director, he has brought many minimally invasive programs to TCBH and is working on future projects. He currently sits on numerous committees and is an advocate for innovation in healthcare. He is the physician lead for the Da Vinci Robotic Surgery Program. He also is the Chair of the Innovation Committee.

Dr. Bhargava has a primary focus of providing care for her patients in the form of minimally invasive procedures and cutting edge technology. She is the Medical Director of TCBH Surgical Centre (The Clinic at Beverly Hills Healthcare) and has been instrumental in bringing Laser Hemorrhoid Treatment to her Centre.

Achievements:
Dr. Bhargava completed both her medical school and surgical residency at the University of Western Ontario. In addition to her Bariatric fellowship, she has also completed Minimally Invasive fellowship at the University of Cincinnati in Ohio.
Dr. Bhargava has published multiple research papers and lead articles.

Memberships:
Canadian Medical Association, Canadian Association of General Surgeons, Society of American Gastrointestinal and Endoscopic Surgeons, Royal College of Physicians and Surgeons of Canada, College of Physicians and Surgeons of Ontario, and American Society of Bariatric Surgery