Exploring the Marvels of Gastrointestinal Endoscopy

Gastrointestinal endoscopy is a medical procedure aimed at examining the upper part of the digestive system, including the esophagus, stomach, and intestines. This method involves introducing a small endoscope tube equipped with a light and a tiny camera through the patient's nose or mouth into the esophagus, stomach, and intestines. The camera captures images, enabling doctors to easily identify any abnormalities in the digestive tract, thus facilitating early diagnosis and accurate assessment of gastric and digestive system disorders that the patient may be experiencing.

During the endoscopy procedure, doctors may also utilize special tools to cut polyps, perform biopsies, control bleeding, extract foreign objects from the digestive tract, address narrow areas, and dilate constricted esophageal veins.

Diagnosing digestive tract disorders through gastrointestinal endoscopy offers higher accuracy compared to ultrasound or X-ray imaging. Besides diagnostic purposes, gastrointestinal endoscopy is prescribed for treating gastrointestinal bleeding, retrieving objects from the digestive tract, and obtaining biopsy samples (for histological examination in suspected cases of cancer or assessing patients for Helicobacter pylori infection).

Currently, there are three methods for gastric endoscopy. Each method has its own advantages, disadvantages, and specific indications for particular medical conditions.

Oral Endoscopy

Patient will ingest a solution to clear mucus from the lining and then receive throat anesthesia to minimize discomfort when inserting the endoscope.

The doctor inserts a flexible endoscope from the throat to the stomach. Images from the camera on the endoscope are transmitted to a screen, allowing the doctor to observe and make diagnoses. During the procedure, the patient cannot speak but continues to breathe normally.

Advantages and disadvantages of oral gastric endoscopy:

• Advantages: Easy to perform, high accuracy, cost-effective, suitable for various patients.
• Disadvantages: Some individuals may feel discomfort, experience throat irritation, or nausea. Deep breathing and slow exhaling can alleviate these symptoms.

Nasal Endoscopy

The doctor applies anesthetic to the nose and throat to numb the patient. The endoscope, coated with anesthetic, is passed through the nose into the back of the mouth. The patient is asked to swallow gently. The endoscope continues through the esophagus and into the stomach, with the camera transmitting images to an external monitor for the doctor to monitor. If any abnormalities are detected, the doctor captures images for further examination.

Advantages and disadvantages of nasal gastric endoscopy:

• Advantages: Easy to perform, high accuracy, the smaller diameter of the endoscope causes less nausea and discomfort.
• Disadvantages: Not feasible if the patient has nasal conditions, nasal constriction, and higher cost compared to oral gastric endoscopy.

Sedated Gastric Endoscopy - Painless Experience

This is essentially oral gastric endoscopy but with sedation, usually recommended for patients with fear or requests for a painless experience.

Advantages and disadvantages of sedated gastric endoscopy:

• Advantages: Painless for the patient, no risky movements such as jerking or pulling the endoscope (for those with a fear of the procedure). Doctors can easily and safely perform procedures like foreign object retrieval, ulcer bleeding control, and dilation of strictures.
• Disadvantages: Higher cost, complex procedure requiring the support of an anesthesiologist, and additional tests may be required before the endoscopy. Some patients may feel tired or drowsy due to sedation and require close monitoring.

Patients are recommended nasal gastric endoscopy for the following purposes:

Diagnosis: Gastric endoscopy helps doctors diagnose disorders and identify the causes of symptoms such as nausea, vomiting, bloating, indigestion, difficulty swallowing, and abdominal pain. When necessary, the doctor may conduct tests during the endoscopy:

• Clo-test for H.Pylori (HP) infection diagnosis: A small tissue sample from an inflamed or ulcerated area is placed in a container with the Clo-test reagent, and the color change of the chemical is observed. If the test turns pink, it indicates the presence of HP bacteria, resulting in a positive (+) Clo-test.
• Cancer detection biopsy: The doctor takes a small tissue sample and examines it under a microscope to reveal cancerous cells if present. This biopsy procedure is painless and comfortable for the patient.

Treatment: Using specialized tools passed through the endoscope, doctors can treat gastrointestinal disorders such as gastrointestinal bleeding, object retrieval from the gastrointestinal tract, polyp removal, or esophageal dilation.

Consider the following before undergoing gastric endoscopy:

• Fast for at least 6 hours before the procedure. You may schedule the endoscopy in the morning before having breakfast.
• Avoid consuming colored liquids such as coffee, milk, orange juice, carbonated beverages before the endoscopy. You may drink clear water in moderation.
• Refrain from smoking to help the doctor observe and examine any lesions clearly.
• Avoid using stomach-cleansing medications (such as Phosphalugel, commonly known as the 'P packet'; Gastropulgite,…) or activated charcoal tablets before the endoscopy.
• If you have allergies to anesthesia, sedatives, or medical instruments, inform the doctor before the gastric endoscopy.
• With sedated endoscopy, there will be a recovery period, and the effects of the sedative will wear off completely (usually about 1 hour). Do not drive or operate vehicles independently within 24 hours after endoscopy. It's advisable to have a companion for transportation.
  

Gastric endoscopy is a relatively safe procedure. Patients should maintain a relaxed mindset and avoid excessive stress or anxiety before the endoscopy. Learn from doctors and individuals who have undergone gastric endoscopy for a clearer perspective on the procedure.

Individuals Recommended for Gastric Endoscopy:

• People experiencing unusual symptoms such as chest pain, upper abdominal pain, nausea, vomiting, belching, indigestion, dark stools, or bloody stools.
• Chronic gastritis patients should undergo regular gastric endoscopy (twice a year), mild to moderate gastritis patients should undergo endoscopy every 3 years.
• Individuals with unhealthy lifestyles, frequent smoking, and alcohol consumption.
• Those with a family history of gastric disorders, especially gastric cancer, and who notice abnormalities in the upper abdominal region.
• Early detection screening for gastric cancer and esophageal disorders.

When a doctor recommends endoscopy, patients should actively cooperate. Gastric endoscopy is a relatively safe procedure, widely practiced, and patients need not worry excessively. After a period of treatment, patients should undergo endoscopy again to evaluate the results.

Individuals Not Recommended for Gastric Endoscopy:
Currently, there are no absolute contraindications to gastric endoscopy. However, a doctor may postpone endoscopy if there are suspicions of:

• Acid ingestion burns
• Perforation of the stomach or other locations in the digestive tract
• Heart failure, coronary artery disease, heart attack
• Respiratory failure
• Large aneurysm in the main artery or a hernia in the esophagus
• Psychiatric disorders lacking coordination
• Recently eaten a heavy meal

Gastric endoscopy and biopsy are generally safe procedures, with complications being rare.

Occasional bleeding complications (1/1000) may occur due to vomiting or post-polyp biopsy. These are usually minor injuries that can stop bleeding on their own or be managed during the endoscopy. In rare cases, surgery may be required to control bleeding.

Perforation complications are extremely rare (1/5000) and, if they occur, may necessitate surgery. Cardiovascular events or the risk of aspiration into the lungs are rare, mainly affecting frail elderly patients with a history of heart or lung disease.

Missing lesions (polyps, etc.) during endoscopy often result from patients having food residue in the stomach, consuming hard-to-digest foods, or not cooperating during the procedure, affecting observation and detection capabilities. Other complications, such as allergies or reactions to medications used during endoscopy (anesthetics, etc.), may occur. However, these complications rarely lead to fatalities.

In general, gastric endoscopy is a safe procedure. It is crucial for patients to seek medical attention promptly for any unusual issues during or after endoscopy (even days later) at a healthcare facility or inform healthcare professionals for early diagnosis and intervention.

After gastric endoscopy, consider the following:

• Avoid consuming any food or drink for about 1-2 hours after endoscopy.
• Endoscopy might induce nausea as the endoscope tube delves deep into the stomach. However, this discomfort will quickly fade without the need for medication.
• Gastric endoscopy may lead to symptoms such as a sore throat, cough, etc., during or after the procedure. Rinsing the mouth with saltwater can rapidly alleviate discomfort. Additionally, focus on incorporating beneficial foods that soothe the throat, such as fresh milk, thin porridge, easily digestible soups, and limit spicy, hot, highly acidic foods, and stimulant-containing beverages to avoid uncomfortable symptoms.
• If you experience difficulty swallowing or throat irritation, you may pause eating and take a rest. In case of any other unusual signs, seek medical attention at a reputable healthcare facility for examination and assessment by a doctor.
• If you observe signs of infection or experience symptoms such as bleeding, dark stools, vomiting blood, promptly visit a healthcare facility for timely intervention.

Furthermore, endoscopy results will be available on the same day. If a biopsy is performed, biopsy results will be provided after a few days.