Gastroscopy & Colonoscopy

What is a Gastroscopy?

Gastroscopy (also known as Upper GI endoscopy) is a procedure that allows the examination of the upper part of the gastrointestinal tract.

This includes

• the oesophagus (food pipe)
• stomach, and
• Duodenum (the first part of the small intestine),

using a thin flexible tube with a built-in video camera, lens and light source (gastroscope). The images are displayed on a monitor for the surgeon.

The gastroscope is put down from the mouth, oesophagus and stomach into the duodenum. The lining is visually examined and small samples (biopsies) are taken for further tests.

A Gastroscopy enables a diagnosis to be made upon which specific treatment can be given. If a bleeding site is identified, treatment can stop the bleeding, or if a polyp is found, it can be removed without a major operation.

Other treatments can be given through the endoscope when necessary.

What are the Indications for a Gastroscopy?

Upper GI endoscopy can be helpful in the evaluation or diagnosis of various problems, including

• Difficulty or pain when swallowing
• Pain in the stomach or abdomen,
• Tumours.
• G.I. bleeding- hematemesis, melena, or iron-deficiency anaemia
• Troublesome heartburn
• Persistent ulcer-like pain
• Dyspepsia
• Anorexia or weight loss
• Taking aspirin or NSAIDs
• History of gastric ulcer
• Persistent nausea, vomiting, or symptoms suggestive of pyloric obstruction
• Gastric ulcer demonstrated by barium meal
• Duodenal biopsy for suspected malabsorption

Gastroscopy for Diagnosis

Gastroscopy is usually performed to evaluate symptoms of upper abdominal pain, nausea, vomiting, weight loss, difficulty swallowing and bleeding.

Gastroscopy is the most accurate means of detecting inflammation and ulcers of the oesophagus, stomach and duodenum.

Gastroscopy can detect early cancer and by performing biopsies (taking small tissue samples) doctors can distinguish between benign and malignant (cancer) conditions. Biopsies are taken for many reasons and do not necessarily mean that cancer is suspected.

Gastroscopy for Treatment

Gastroscopy may be used to treat conditions present in the upper gastrointestinal tract. A variety of instruments can be passed through the endoscope, which allows many abnormalities to be treated directly, with little or no discomfort. For example,

• stretching narrowed areas,
• removing polyps or
• treating upper gastrointestinal bleeding.

Preparation Before Your Procedure

Before gastroscopy, the stomach must be completely empty for a safe and accurate examination.

• have nothing to eat, for six (6) hours before the examination.
• may drink plain water (only) until two (2) hours before you come to the hospital.

The hospital will give specific information about the time to begin fasting, depending on the time of day that your test is scheduled.

Medications Before the Procedure

You will be informed by our team when to stop eating and drinking or stop taking usual medicine depending on the time of day your procedure has been scheduled.

Most medicines can be taken, as usual, however, if you are unsure please speak to your doctor/anaesthetist.

• Diabetes medications: omit your diabetes tablets on the morning of the test. If you take insulin you should take half your usual dose. The nurses will check your blood sugar when you arrive at the hospital.
• Blood-thinning medicines: anticoagulants (blood thinners) such as warfarin (Coumadin), apixaban, etc. must be stopped for 3 to 5 days. You must discuss this with your own doctor as you may need to have injections during this period.
• Antiplatelet agents such as clopidogrel (Plavix) usually need to stop for one week. If you have stents in your heart DO NOT stop any medicine without your cardiologist’s permission. If necessary, aspirin can be continued up to the day of the test.
• Most other drugs (for high blood pressure, cholesterol, depression, reflux, etc., can be taken up to 2 hours before coming to the hospital with some water.

What Can Be Expected During a Gastroscopy?

A gastroscopy is usually performed under sedation. This can often be called twilight general anaesthesia. You are not awake or aware for the procedure but are in control of your own breathing.

The procedure takes approximately 15 -30 minutes to complete.

Upper GI endoscopy is usually performed on an outpatient basis.

Like a Colonoscope, an endoscope is a long, thin, flexible tube with a tiny video camera and light at the end.

While you are in a comfortable position on your left side, the endoscope is passed through your mouth and then in turn through the oesophagus, stomach and duodenum.

By adjusting the various controls on the endoscope, the endoscopist can safely guide the instrument to carefully examine the inside lining of the upper digestive system. The high-quality picture from the endoscope is shown on a TV monitor which gives a clear, detailed view. In many cases, upper GI endoscopy is a more precise examination than X-ray studies.

What happens after the Gastroscopy?

After the test, you will be monitored in a recovery area until most of the effects of the anaesthetic have worn off.

Your throat may be a little sore for a while, and you may feel bloated right after the procedure because of the air introduced into your stomach during the procedure.

You will be given something to eat and drink when you are awake. In most cases, Dr Manley will inform you of your test results on the day of the procedure, however, the results of any biopsies taken will take several days.

Recovery from Gastroscopy Procedure

You will need to arrange to have someone accompany you home from the examination and stay with you the night after your procedure. Until the following day we recommend patients do not:

• Drive a car
• Work machinery
• Consume alcohol
• Sign legal documents
• Make important decisions

If any of your questions have not been answered here, please feel free to discuss them with the endoscopy nurse or Dr Manley before the procedure begins.

What Are The Risk Or Side Effects?

Endoscopy is safe. Complications can occur but they are rare when the test is performed by doctors with specialised training and experience in the procedure.

Although complications can occur after a gastroscopy, they are rare when performed by doctors who are specially trained in gastroscopy. In Australia, very few people experience serious complications from gastroscopy.

• Your throat might be a little sore and might feel bloated due to the air introduced into your / child’s stomach during the procedure.
• A small amount of blood might be seen in your saliva after gastroscopy. Rarely bleeding may occur from a biopsy site, or where a polyp has been removed. This is usually minimal and rarely requires blood transfusions or surgery.
• In extremely rare situations the lining of the stomach could be torn that may require an operation to repair it.
• Reactions to sedatives are also possible, but again are very rare.
• In very few cases, if the gastroscopy could not be successfully completed it may need to be repeated.

When Do I Seek Help?

If you have the following symptoms in the hours or days after the gastroscopy you should contact the rooms or proceed to the closest emergency department.

• Vomited more than 2 to 3 times
• Vomit with more than a teaspoon) of bright red blood in it
• Passing black tar-like stools
• Fever (Temperature above 38 degrees Celsius)
• Increasing throat, chest or abdominal pain
• Difficulty swallowing
• Any other symptoms that cause concern

What is a Colonoscopy

A Colonoscopy is an endoscopic procedure used to view or examine the inside surface of the large intestine (colon and rectum) or large bowel.

A Colonoscopy is a procedure performed to detect irregularities such as

• inflamed tissue,
• ulcers, and
• abnormal growths. 

Specifically, a Colonoscopy helps in the diagnosis of:

• colorectal cancer,
• bowel disorders,
• abdominal pain,
• inflamed tissue,
• ulcers, and
• anal bleeding.

Preparing for a Colonoscopy

In order to be able to properly visualise the inside of the colon during the procedure and accurately assess the bowel, you will be required to modify your diet and take laxatives to clear the bowels.

The day prior you will be required to change to a clear fluid diet and commence taking bowel preparation. Further instructions will be provided.

Ensure that you remain well hydrated during this period and drink plenty of liquid to prevent dehydration. Keep warm. You may wish to apply protective cream such as lanolin or have a warm bath to soothe any discomfort or redness in the anal region.

Remember it is important to complete the bowel preparation in order to visualise the bowel properly.

Colonoscope Device

An instrument called a colonoscope is used during a colonoscopy. This instrument includes:

• A long thin flexible tube
• A small camera and light at the end, and
• Other instruments can be added

By adjusting the various controls on the colonoscope or endoscope, your doctor can safely guide the instrument to carefully examine the inside lining of the digestive system or the upper or lower gastrointestinal tract.

If necessary other instruments can be inserted through the Colonoscope that allows a variety of therapeutic procedures to be carried out during a Colonoscopy procedure.

Such therapeutic procedures may include:

• the taking of tissue samples (biopsies), and
• removal of polyps (benign wart-like growths).

Polyps or growths are removed during a Colonoscopy can be sent later for diagnostic testing to a pathology lab.

About Your Colonoscopy Procedure

Colonoscopy is usually performed under sedation by an anaesthetist. This can often be called twilight general anaesthesia. You are not awake or aware for the procedure but are in control of your own breathing.

The colonoscope is inserted into the bottom end of the anal canal. The colonoscope gently moves up through the rectum and then the colon until it reaches the caecum (junction of the small and large intestine).

The colonoscope is then withdrawn slowly as the camera shows pictures of the colon and rectum on a high-quality screen for a clear and detailed view.

Irregularities During Colonoscopy

Occasionally narrowing of the bowel or other diseases may prevent the instrument from being inserted through the full length of the colon.

As colon cancer arises from pre-existing polyps (benign tumours), it is advisable that if any polyps are found, they are removed at the time of examination.

Most polyps can be burnt off by placing a wire snare around the base and applying an electric current.

How Longs Does a Colonoscopy Take?

You will be in the facility for approximately 2 hours. The procedure usually takes under 45 minutes

Risks and Complications with Colonoscopy

For inspection of the bowel alone, complications of colonoscopy are very uncommon. Most surveys report complications of 1:1000 examinations or less.

Complications that can occur include:

• intolerance of the bowel preparation solution
• reaction to the sedatives while uncommon and can be avoided by administering oxygen during the procedure and monitoring pulse and oxygen levels in the blood.
• Perforation (making a hole in the bowel) or major bleeding from the bowel is extremely rare, but if it occurs may require surgery.

When operations, such as removal of polyps, are carried out at the time of the procedure, there is a slightly higher risk of perforation or bleeding from the site where the polyp was removed.

A number of rare side-effects can occur with an endoscope procedure. If you wish to have full details of such complications explained to you please discuss this with the doctor prior to the examination.

In the unlikely event of a haemorrhage occurring, a blood transfusion may be necessary.

It is important to realize that no test is perfect and small lesions, and rarely even cancers can be missed during colonoscopy. The rate of missed cancer in international literature is 0.01%. For this reason, follow up colonoscopy is often recommended and if there is a change in your symptoms, these should be discussed with your doctor even if you have previously had a colonoscopy.

Who Can I Contact If You Have Any Questions?

Please contact the rooms during weekdays.

After hours proceed to the closest emergency department or your family doctor. In an emergency contact the ambulance service by calling triple zero (000).