GASTROSCOPY
What is a Gastroscopy
Gastroscopy, or upper GI endoscopy, is a procedure where your gastroenterologist examines the lining of the upper part of your gastrointestinal tract, which includes the oesophagus, stomach and duodenum (first part of the small intestine).
Diagnostic gastroscopy
Gastroscopy helps your gastroenterologist evaluate symptoms such as upper abdominal pain, nausea, acid reflux, vomiting, difficulty swallowing and other upper gastrointestinal symptoms. It can also be used to identify the cause of bleeding from the upper gastrointestinal tract, and to detect inflammation, ulcers and tumours of the oesophagus, stomach and duodenum. Your gastroenterologist might obtain biopsies (small tissue samples) to diagnose conditions such as reflux, Barrett’s oesophagus, Helicobacter pylori, benign and cancerous growths and coeliac disease.
Therapeutic gastroscopy
Gastroscopy is also used to treat conditions of the upper gastrointestinal tract. For example, your gastroenterologist may stretch (dilate) a narrowed area, remove pre-cancerous or early cancerous growths or treat bleeding. Some examples include:
Endoscopic resection
Endoscopic resection is a minimally invasive endoscopic technique used to remove pathological tissue from the gastrointestinal tract.
Endoscopic Mucosal Resection (EMR)
Endoscopic Mucosal Resection (EMR) removes lesions from the mucosal (inner) layer of gastrointestinal tract using a snare. EMR is used for conditions such as pre-cancerous oesophageal squamous lesions and Barrett’s oesophagus, and polyps in the stomach, duodenum and colorectum. EMR is typically performed as a day procedure.
Endoscopic Submucosal Dissection (ESD)
Endoscopic Submucosal Dissection (ESD) is a technique that allows removal of pre-cancerous and early cancerous lesions from the oesophagus, stomach and colorectum. ESD is performed using an endoscopic knife, and this allows lesions to be removed as a single specimen (en bloc). ESD typically requires a general anaesthetic and overnight hospital admission.
Submucosal Tunnel Endoscopic Resection (STER)
Submucosal Tunnel Endoscopic Resection (STER) is an advanced minimally invasive technique employed for the excision of submucosal tumors in the gastrointestinal tract.
Radiofrequency Ablation (RFA)
Radiofrequency ablation (RFA) is used to treat Barrett’s oesophagus with early pre-cancerous changes, and is performed during a gastroscopy. RFA is typically performed as a day procedure.
Motility disorders:
The diagnosis of gastrointestinal motility disorders such as achalasia, diffuse oesophageal spasm and gastroparesis usually requires several investigations, which can include a gastroscopy, high resolution manometry, swallow study or gastric emptying study. Motility disorders are usually managed with a combination of dietary, behavioural changes and medications, and some patients may benefit from endoscopic intervention. Some examples include:
Oesophageal Per Oral Endoscopic Myotomy (0-POEM)
Oesophageal Per Oral Endoscopic Myotomy (O-POEM) is a procedure that treats achalasia and diffuse oesophageal spasm, which are conditions characterised by overactive muscles in the lower oesophagus that leads to trouble swallowing.
Zenker’s Per oral Endoscopic Myotomy (Z-POEM)
Zenker’s Per Oral Endoscopic Myotomy (Z-POEM) is a procedure that treats Zenker’s diverticulum (a pharyngeal pouch) and a similar technique is used to treat a cricopharyngeal bar. These conditions affect the upper oesophagus, and are characterised by difficulty swallowing, with or without regurgitation.
Gastric Per Oral Endoscopic Myotomy (G-POEM)
Gastric Per Oral Endoscopic Myotomy (G-POEM) is a procedure where the pylorus muscle at the exit of the stomach is opened and is also known as an endoscopic pyloromyotomy. G-POEM is performed for gastroparesis, usually in combination with dietary, behavioural and medication therapy.
Achalasia Balloon dilation
Achalasia balloon dilation is a technique used to treat achalasia. It involves passing a balloon alongside the gastroscope to dilate the lower oesophageal sphincter, which is at the junction of the oesophagus and stomach.
Botulinum toxin injection (“Botox” injection)
Botulinum toxin can be injected through the gastroscope to temporarily paralyse the muscle of the lower oesophageal sphincter or the pylorus. It is part of the treatment options to manage achalasia and gastroparesis.
Strictures
A stricture is an area of narrowing of the gastrointestinal lumen which can slow or obstruct the normal passage of food and gastrointestinal contents. Strictures can occur anywhere from the oesophagus to the rectum. The treatment depends on the underlying cause of the stricture and may involve dilating or stretching the stricture, placing a stent or injecting medications during the endoscopic procedure.
Bleeding
Endoscopy is used to diagnose and treat conditions in the gastrointestinal tract that may or already have caused bleeding. Bleeding can be acute (sudden) or chronic, for example presenting with an iron deficiency anaemia. Causes of upper GI bleeding includes varices (dilated veins of the oesophagus or stomach), ulcers, gastric antral vascular ectasia (GAVE), arteriovenous malformations (AVMs) and growths.
Fistulas
Fistulas are openings between two structures in the upper GI tract and can occur after surgery or PEG tube (percutaneous enteral gastrostomy) removal. When fistulas do not close by themselves and are causing symptoms, endoscopic management including internal drainage or closure can be performed.
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