An upper gastrointestinal (GI) endoscopy (otherwise known as gastroscopy or simply an endoscopy) is a very safe and effective investigation that lets your doctor examine the lining of the upper part of your gastrointestinal tract. This includes the oesophagus, stomach and duodenum (first portion of the small intestine).

In order to do the test your consultant will use a thin (thinner than your little finger), flexible tube called an endoscope. This has steering controls at one end and a digital camera and a bright light at the other. The detailed colour images of the oesophagus, stomach and duodenum are displayed on a video monitor. The endoscope also allows the consultant to obtain tissue samples (biopsies), this process is painless.

Your doctor has recommended an endoscopy. However, it is your decision whether to go ahead with the procedure or not. This information will explain the benefits and risks to help you make an informed decision.

An upper GI endoscopy helps your doctor evaluate symptoms of persistent upper abdominal pain, nausea, vomiting or difficulty swallowing. It's an excellent test for finding the cause of bleeding from the upper gastrointestinal tract. It's also more accurate than X-ray films for detecting inflammation, ulcers and tumors of the oesophagus, stomach and duodenum. If your doctor does see a problem during the endoscopy, they may perform a biopsy (removing a small piece of tissue).

If the endoscopy is normal, your doctor may be able to tell you straightaway and you will be reassured.

Endoscopy has been a major advance in the treatment of gastrointestinal diseases. For example, the use of endoscopes allows the detection of ulcers, cancers, polyps, and sites of internal bleeding. Through endoscopy, tissue samples (biopsies) may be obtained, areas of blockage can be opened, and active bleeding can be stopped.

Endoscopy is easily carried out on an outpatient basis and is very well tolerated by patients. The technique of endoscopy is extremely safe, with very low rates of complications, when performed by a properly trained consultant.

A barium meal (X-ray test of the upper digestive system), although this test is not as accurate as an upper GI endoscopy, and if a problem is found you may still need an upper GI endoscopy to perform biopsies.

Your doctor may not be able to confirm what the problem is. If you decide not to have a endoscopy, you should discuss this carefully with your doctor.

• Before the Endoscopy

Your stomach needs to be empty to conduct the test safely and for the consultant to get an adequate view. Therefore, you will be asked not to eat or drink anything for 6 hours before the test (this does not include routine medication which should be taken as normal).

On arrival in the endoscopy unit the staff will explain the procedure to you and the consultant will ask you to sign a consent form. This is to ensure that you understand the implications of the procedure and are happy to proceed. You will be asked to remove any false teeth, these will be kept safely until the test is complete.
Sedation
A sedative is not always required for the test but is available on request. If you wish to have sedation a needle is placed in your hand or arm and a sedative (midazolam) administered immediately before the endoscopy. The sedative acts for a very short period and will help you to relax during the test. If you are considering having sedation you will need someone to bring you to the clinic and to drive you home. You should not drive for 24 hours after having  sedation.

• During the Endoscopy

The consultant will spray the back of your throat with local anaesthetic.. You will then be asked to lie on your left side on a couch. A peg will be placed on your finger to monitor your pulse and oxygen level and a plastic mouthpiece will be placed between your teeth.
The endoscope is passed through your mouth and into your stomach. This does not cause any pain and does not interfere with your breathing. It is rare for an Upper GI endoscopy to take more than 10 - 15 minutes. It is painless although your stomach may feel bloated because air will be blown into it (this improves the view for the consultant). The air will be removed at the end of the procedure.

• After the procedure

Once the test is completed you will be transferred to the recovery area. You will not be able to eat or drink anything until the local anaesthetic wears off (to avoid food or fluid “going down the wrong way”). This may take up to 45 mins.
You may feel a bit bloated for a few hours, but this will pass. You should be able to go home straightaway and resume normal activities. A member of the team will tell you what was found during the endoscopy and will discuss any treatment and follow up appointments you may need. You should be able to go back to work the day after the endoscopy unless you are told otherwise. For further information, speak to your consultant or a member of the endoscopy team.

What complications can happen?

Upper gastrointestinal endoscopy is a very safe procedure, with a risk of significant complications of only 1 in 10,000 procedures. The experienced healthcare team will make every effort to minimize any risk associated with the procedure. However, there are potential complications of endoscopy and these are listed below.

• There is a possibility of damaging loose teeth. If you have any caps or crowns or wobbly teeth you should let the healthcare team know.
• Significant bleeding or perforation of the GI tract are very rare but recognized complications that may require surgery to correct.
• An adverse reaction to the sedation. This is very unusual and you will be adequately monitored until the sedation has worn off.

If you have any specific concerns about the procedure please raise these with the healthcare staff or consultant.