Upper GI Endoscopy (Gastroscopy)
What is UGIE?
UGIE is a procedure that allows your specialist to examine, while you are under a light anaesthetic, through the throat (pharynx) down the oesophagus, into the stomach and into the duodenum, or outlet of the stomach, which is the first part of the small intestine. Another description for this traditionally used is gastroscopy. The telescope used is a flexible telescope about the thickness of a pen, with a digital camera in the end, so that vision is on a television screen.
Why is UGIE done?
A UGIE is done when there may be symptoms of upper digestive problems including gastro-oesophageal reflux (heartburn and acid regurgitation), upper abdominal pain, excess nausea or vomiting (sometimes of blood) and sometimes to examine for healing of previously diagnosed ulcers. Problems with difficulty in swallowing include investigations with UGIE to look for causes.
What may be found at UGIE?
- There may be signs found of acid reflux up the oesophagus (gullet), with or without hiatal hernia.
- Barrett’s oesophagus can be examined, and if diagnosed can be followed up into the future to prevent cellular changes with small risks of cancer formation.
- New ulcers can be diagnosed either in the oesophagus stomach or duodenum.
- Helicobacter infection in the stomach is always biopsied for and if present can be treated to prevent people developing ulcers.
- Cancers of the stomach or oesophagus can be diagnosed.
Is the UGIE procedure painful?
No – Because of the intravenous sedation anaesthesia you should feel no pain and not be aware. You will wake up rapidly after the procedure however, and should not remember much if anything about the procedure at all. Before you go home it is usual for Professor Danne to speak to you about the findings.
Are there any side effects or complications?
Complications from a gastroscopy are extremely rare. Perforation occurs in less than 0.01% of people. Sometimes there is a little bit of soreness in the throat, which settles very soon, but in most people the procedure is free of any complications at all.
Other complications such as heart or lung are also extremely rare, less than 0.05%. Aspiration during the procedure is occasionally an occurrence, in people with severe reflux, but you are in the hands of very well trained anaesthetists who are monitoring and looking after you to prevent this.
Any preparation before UGIE?
You must bring your doctor’s referral with you if you have not already seen Professor Danne in consultation. You need to make an appointment for the gastroscopy, and you will be instructed not to have anything eat or drink for at least four hours prior to your arrival at the appointed time at hospital. You need to have someone accompany you who can take you home at the end of the procedure. Having had an anaesthetic means that you must be accompanied home by someone who is caring for you. You will, however, in almost all cases be able to undertake your normal activities the following day.
During the procedure?
The procedure takes approximately 10 to 20 minutes, depending upon what is needed to be done. Sometimes polyps are seen and some of these are removed. Biopsies are usually done. None of these cause any pain and very little risk of any significant bleeding. The specimens removed are usually sent to pathology for examination under the microscope and these results will be reported to you by Professor Danne or by your GP when you return for consultation with either of them.
Medications?
You will often need to cease some medications for seven days prior to the procedure – These include Warfarin, Clopidogrel, Persantin, and anti-diarrhoeal agents. Low dose Aspirin (100 mg daily) can usually be continued.
You should be given advice about the anticoagulants that you may need to cease or whether you can continue those.
Nexium or similar Proton Pump Inhibitor medications (eg Somac, Pariet) should be ceased for 10 days to two weeks prior to surgery. You are able to continue to use Mylanta or Gaviscon instead, to manage your symptoms. If you problems ceasing these please discuss this with the rooms.
All other usual medications should be taken with sips of water at 6 am on the day of the procedure.
Diabetic medications?
Diabetics should not take their morning insulin or diabetic tablets but should bring them with them to hospital, and test your sugar as routine.
What do I expect after the UGIE?
You may have slight soreness in the throat but this should settle soon. You may feel a little bloated due to air blown through the scope and this can be resolved with burping! This is quite normal. If however any of the following occur within 24 hours please contact your specialist, or your own doctor of the nearest possible hospital:
- Severe or persistent chest pain or upper abdominal pain.
- Vomiting of blood.
- Persistent vomiting.
- Passage of black bowel motions.
- Persistent swelling of the abdomen.
- High temperature or fever.
For most patients they are quite comfortable when going home after UGIE, and in fact feel particularly good. It is important to remember that you have had an anaesthetic however and cannot drive a car, operate machinery, and should not make important decisions or sign important documents on that day, as you would be regarded as still potentially under the influence of the anaesthetic.
How do I receive results?
In almost cases Professor Danne will be talking with you prior to your leaving hospital. You will be advised whether you need to return to see Professor Danne for further discussion or to go to see your local doctor, in which case Professor Danne will be, as is his usual routine, sending a letter and report to your doctor. There may be a discussion of further treatment needed.
Information for diabetic patients
The day prior to a gastroscopy you should have a normal diet, and your medication as per normal also. If you have any concerns during the day prior to gastroscopy, seek the advice of your local doctor or by calling Professor Danne’s rooms. With regard to hospital matters you should talk to the hospital concerned, wherein your procedure will be done.
If you are comfortable with your usual management of diabetes the following course of action is recommended:
- On the day prior to the day of procedure have your normal medications and eat normally.
- For a morning UGIE procedure - Do not have your normal diabetic medication that morning but check your blood glucose, bring your medication with you to the hospital, and if your blood glucose level is high take advice from the hospital staff about having some medication. You can have your medication later in the morning or early afternoon after your procedure is done.
- If the UGIE is in the afternoon, have half your normal diabetic medication doses in the morning, and the rest after your procedure in the afternoon, and keep monitoring your blood sugar.
- If you are not comfortable managing any of this please consult with your local doctor on the day prior to make sure you have got further explanations, or call Professor Danne’s rooms.
In our experience this diabetic management usually serves extremely well for all diabetics. Monitoring your sugar frequently on that day is very important.
INFORMATION FOR DIABETIC PATIENTS PREPARING FOR GASTROSCOPY
The day prior to a Gastroscopy you should not have a normal diet and your medication as per normal also.
If you have any concerns during the day prior to gastroscopy, seek the advice of your local doctor or from the Hospital or Clinic where your procedure will be done or Endoscopist.
If you are not comfortable managing your diabetic situation, please consult the anaesthetist concerned with the procedure, or your local doctor, to make sure that you have appropriate monitoring and advice.
For those comfortable with managing your diabetic state the following course of action is recommended:
- Normal dose of tablets or Insulin on the day prior to the procedure.
- Consult your local doctor or the specialist endoscopist or hospital concerned with the procedure, later that day if you have a concern.
- Do not have your medication on the morning of the procedure, check your blood glucose, if it is abnormally high or low, advise the Hospital of the reading. Otherwise, bring your medication with you to the hospital, so that you can have medication later in the day after the procedure.
If the Gastroscopy is in the afternoon, have half your dose in the morning and the rest after your procedure in the afternoon.