Looking inside the stomach
One example of modern endoscopy that is often performed at Three Rivers Endoscopy Center is gastroscopy. Gastroscopy is a medical term that has two parts - gastro which refers to the stomach and scopy which means "to look." Therefore, gastroscopy is a test that enables the doctor to look inside the stomach. The technical name for this test is Esophago-Gastro-Duodenoscopy. To simplify things the shortened form of the name gastroscopy is usually used, or the initials EGD.

The instrument used to perform this test is called a gastroscope: a long, flexible fiberoptic tube about the width of a pencil. Within the end of this tube is a computerized color video chip with a wide-angle lens. The other end has a control handle which allows the doctor to move the tip of the instrument in any direction - much like a videogame. By passing this "scope" into the mouth and down into the stomach, doctors can directly examine the lining of the upper digestive system on a high-resolution video monitor. The modern gastroscope is over 4 feet in length - long enough to visualize the esophagus, the stomach and the first portion of the small intestine called the duodenum. The examination is quick and accurate. There is no incision.

It sounds terrible, but it's not.
Understandably, most patients are a bit apprehensive about the idea of "swallowing a scope." However, with the help of modern technology and sedation, patients usually tolerate this test with ease. This is because immediately before the examination patients are placed comfortably on their left side and given medications which cause a state of drowsiness and relaxation often called "twilight sleep." These medications work quite well and prevent any discomfort during the examination. A frequent fear expressed by patients is that they will choke during the exam or 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.

Since the gastroscope enters the esophagus or "food pipe" and NOT the trachea, or "windpipe," it does not interfere with the ability to breathe. After the test is completed, most patients are pleasantly surprised and often ask, "When is the test going to start?" Another common concern is that patients will act silly or say things they shouldn't while they are asleep. Rest assured that these medications do not cause one to act or speak foolishly or divulge any secrets.

Why perform a gastroscopy?
There are many reasons why a doctor would recommend a gastroscopy 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 Acid reflux (GERD) Barrett's Esophagus Bleeding from the digestive tract Cancers of the stomach or esophagus Celiac Disease (Gluten intolerance) Chronic heartburn and indigestion Dilatation of esophageal strictures Gastritis, or stomach inflammation Helicobacter pylori "Ulcer Bacteria" Hiatal hernia Nausea/Vomiting Removal of swallowed objects Stomach polyps Trouble swallowing Ulcers of the esophagus Ulcers of the stomach Ulcers of the duodenum Unexplained chest pain Unexplained weight loss

A simple preparation
A gastroscopy exam requires very little preparation. Of course, the stomach must be empty for an accurate examination, so patients are asked not to eat or drink for at least six hours before the test. Since sedation is used to make the test painless, a companion, usually a family member, must accompany the patient to drive them home. The average exam takes less than 20 minutes, but the effects of the sedative linger, so patients must rest for a while in the recovery room. The average time from arrival to discharge is usually less than two hours. Patients are not able to return to work that day and are not permitted to drive for at least 12 hours. They may eat normally upon returning home.

Instant gratification
One nice thing about endoscopy is that there is no waiting for results. Unlike an x-ray which must be developed and then later interpreted by a radiologist, the results of a gastroscopy are immediately available. Newer computerized systems allow a completed report with color photographs to be printed within minutes of the examination. The doctor can review the report and make or discuss recommendations with the patient and family during same visit. Of course, any specimens or biopsies that are obtained have to be sent to the laboratory and those results may take up to a week.

Not just pretty pictures...
The modern gastroscope is a highly complex instrument that allows the doctor to not only see what is inside, but also, to perform a variety of other actions. There is an air channel though which the doctor can gently infuse air and open up the stomach so that an accurate view can be obtained. If a small amount of fluid or debris is present, there is a little vacuum cleaner built right in. If the camera lens should be partially obscured by a bit of mucus, there is a windshield spray that clears the way. If gastroscopy reveals any abnormal condition such as an ulcer, the doctor may photograph it. This color photo provides a permanent record for the medical chart and also enables other doctors to see what is wrong.

To better evaluate areas of abnormality, the 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, the 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. If there are problems with swallowing and the doctor finds a narrowed area in the esophagus, it may be possible to dilate this "stricture" during this exam with a small balloon which is also passed through a channel in the gastroscope. Occasionally, we are called to perform an emergency endoscopy to remove a foreign object that is stuck in someone's esophagus. Lastly, gastroscopy has the ability to apply a small metal clip or to cauterize and stop a bleeding ulcer, preventing the need for major abdominal surgery in the majority of cases.

Is gastroscopy dangerous?
No. While every medical procedure involves some degree of risk, complications are extremely rare in patients undergoing gastroscopy. Possible complications inlcude drug reactions, infection, bleeding, or perforation of the digestive tract which might require surgery. However, with the advent of flexible fiberoptic instruments, this procedure has become an extremely safe and simple diagnostic technique. All examinations are performed in a highly regulated environment with careful monitoring of all vital signs. When performed by a physician who is specially trained and experienced in the procedure, the benefits of gastroscopy far exceed the risks.

How are the instruments sterilized?
In this day and age, this is a common and understandable concern. We take your safety very seriously. Three Rivers Endoscopy Center has the latest Custom Ultrasonics Washer-Disinfector system which is computer controlled to assure that every instrument is thoroughly cleaned and undergoes high-level disinfection after each use. Only techniques known to kill all disease-causing bacteria and viruses, including the hepatitis and AIDS virus, are employed in this process. All techniques and sterilants are approved by the Food and Drug Administration (FDA) and American Society for Gastrointestinal Endoscopy (ASGE), the American Gastroenterological Association (AGA), the American College of Gastroenterology (ACG), and the Association for Professionals in Infection Control (APIC). All accessories are cleaned and sterilized by our dedicated staff using our two high temperature steam autoclaves. Our patients can be confident in the fact that they are not risking infection during a scope examination.

A valuable tool
In summary, gastroscopy is a valuable tool for the diagnosis and treatment of diseases of the upper digestive tract. More accurate than a barium x-ray and much simpler than exploratory surgery, gastroscopy is a safe and highly effective diagnostic technique. This technique is useful in the diagnosis and follow-up of patients with peptic ulcers, acid reflux disease, Barretts esophagus, and allows dilatation of esophageal strictures. Gastroscopy is an extremely safe and worthwhile procedure that is very well tolerated.

TWO UNUSUAL EXAMPLES OF GASTROSCOPY
One of the common uses of gastroscopy is in the removal of objects stuck in the upper digestive tract. This is most common in children, but we also see cases involing adults when there is a narrowing, or stricture, in the esophagus. This woman came to Three Rivers Endoscopy Center complaining that she could not swallow. During her gastroscopy exam, we found this large meatball lodged in her lower esophagus, or "food pipe." The meatball was removed during the exam and she felt much better. The real question is how could she swallow it whole?? Click HERE to see what we found above the meatball.	Here is an example of how gastroscopy is sometimes used to make a molehill out of a mountain. This 28 year old mom was trying to do the right thing by sewing a Merit Badge on her daughter's Girl Scout uniform. Like most moms, she was in a hurry. While adjusting the material, she placed the needle and thread between her lips. When she pulled on the thread, it came loose and the needle fell into her mouth. Before she realized it, she accidently swallowed it. After several hours, she came to our local emergency department. The ER doctor obtained an abdominal x-ray which showed that the needle was still inside her stomach. It had not yet entered the small intestine. We were called in to perform an emergency gastroscopy exam and successfully removed the needle - avoiding the need for major surgery.