Gastroscopy (gastroscopy) – treatment, effect and risks

Gastroscopy is a mostly painless diagnostic method with which the esophagus , stomach and duodenum can be examined in detail. The so-called endoscope (gastroscope) is used, a flexible plastic tube about one meter long with a diameter of less than one centimeter.

The working tool has several channels and is equipped with lighting and a mini video camera. The gastroscopy is performed on an outpatient basis in the practice of the gastroenterologist or as an inpatient during a hospital stay.

application and function

Gastroscopy is not only used for the medical examination of the upper digestive organs, but also for their treatment. In medical diagnostics, the gastroscope is used to clarify frequent heartburn , vomiting blood , an increased feeling of fullness , chronic coughing , prolonged upper abdominal complaints of unknown cause, chronic difficulty swallowing , reflux diseases such as esophagitis , mucosal injuries, blood in the stool and celiac disease / sprue used.It also helps to detect esophageal varices (varicose veins in the esophagus), gastritis , Helicobacter pylori infection, ulcer diseases, diverticula, esophageal, colon and stomach cancer .

To find out if a patient has gastritis, the gastroenterologist removes a tiny piece of mucous membrane from the stomach (biopsy) and has it examined in the laboratory. Bleeding stomach ulcers are injected with medication to stop the bleeding or closed with a special rubber band.

During the gastroscopy, the doctor can also remove accidentally swallowed objects from the stomach and widen narrowed gastric outlets. Benign growths in the gastric mucosa ( stomach polyps ) can be removed and gastric tubes placed.

methods and procedures

Gastroscopy is a proven and safe medical procedure that is used to diagnose and treat certain diseases of the stomach, duodenum and esophagus. To do this, the gastroenterologist uses the gastroscope, a flexible device that the patient swallows or – if this is too uncomfortable for him – that is inserted through a nostril .

What does the patient have to consider?

The patient must be fasting for the gastroscopy. The last meal should be at least 6 hours ago. This is necessary because leftover food obstructs the view. There is also a risk that the patient will accidentally push them open and they will then get into their airways (aspiration). Before the gastroscopy, he must also remove braces or dentures.

Before the actual examination, the doctor often places a venous access via which the patient can be supplied with liquid and/or medication immediately in an emergency. This is necessary, for example, if the doctor detects a critical drop in blood pressure.

The doctor numbs the mouth and throat with a special spray to eliminate the annoying gag reflex when the tube is pushed down. In this regard, the patient should note that they should not eat or drink again until the anesthetic wears off, otherwise they could choke. This is usually allowed again after two hours at the latest.

Anxious patients are given a light sedative or, alternatively, a short-term anesthetic (“sleep shot”). After the gastroscopy, the patient should not drive a car, operate dangerous machines or sign important contracts. During the gastroscopy and shortly after the examination, the patient’s pulse and oxygen saturation in the blood are monitored so that medical intervention can be carried out quickly in an emergency.

process and implementation

For gastroscopy, the patient lies on his left side. The endoscope is pushed through the mouth and down the esophagus into the stomach or – if necessary – into the duodenum. The mini video camera inside the gastroscope transmits real-time images to a nearby monitor. By moving the endoscope back and forth, the examining doctor can gradually display every square centimeter of the mucous membrane and search for suspicious signs.

The glass fiber optics, which are also in the plastic tube, provide sufficient light for the gastroscopy. The hose has several channels. The gastroenterologist can insert and operate tiny instruments such as metal loops, forceps, etc. via the working channel. For example, he uses small forceps to remove a piece of gastric mucosa, which is then examined in the laboratory.

He fills the stomach with air via the other channel (air channel, flushing channel) so that the gastric mucosa unfolds. This way he can better examine them for pathological changes. Varying the light composition or dye sprayed on the mucous membrane make tiny details even more visible.

The rinsing device is used to clean the lens located at the end of the gastroscope and to introduce or suck out liquids from the stomach or duodenum. After the gastroscopy is complete, the doctor slowly and carefully pulls the endoscope out again. At the same time, the air blown into the stomach is sucked out. This is necessary so that the patient does not later suffer from an excessive feeling of fullness.

Self-service or health insurance – who will bear the costs?

If there is a medical indication, i.e. if the patient is referred to a gastroenterologist by his doctor, for example, the statutory or private health insurance companies will cover the costs for the gastroscopy. However, privately insured persons must first pay in advance. If the patient wishes to have the examination carried out as a precautionary measure, he must bear the costs himself.

Risks, dangers and complications

Inserting the plastic tube through the esophagus can cause the patient to get hoarse for a short time . Since gastroscopy is an invasive procedure, it can sometimes injure the stomach, intestines and esophagus wall. In very rare cases, the organs are even punctured, so that stomach acid , for example, gets into the abdominal cavity.The removal of mucosal tissue (biopsy) can occasionally cause bleeding, but this is harmless – unless the patient suffers from a blood clotting disorder that the doctor has not previously informed.

In very rare cases, gastric contents can be regurgitated, which gets into the lungs and causes aspiration pneumonia (a type of pneumonia) there. In some patients, gastroscopy causes shortness of breath and abnormal heart rhythms .