GASTROSCOPY

A gastroscopy or
oesophagogastroduodenoscopy (OGD)
is a procedure in which a long flexible
endoscope is passed through the
mouth, allowing the doctor or nurse
endoscopist to look directly at the
mucosal lining of the esophagus,
stomach and proximal duodenum.
The endoscope is generally less than
10 mm in diameter but a larger scope
may be required for therapeutic
procedures where suction channels
are required.
By: fauzie gwapa
ANATOMY AND PHYSIOLOGY
Oesophagus
• The oesophagus is a muscular thin-walled tube
approximately 25 cm long and about 2 cm in
diameter. It is located behind the trachea and in
front of the vertebral column. It begins at the inferior
end of the laryngopharynx and ends at the stomach.
• There are two sphincters within the esophagus: the
upper or hypopharyngeal sphincter and the lower
gastro-oesophageal or cardiac sphincter. The upper
moves food from the pharynx to the desophagus and
the lower the food passing into the stomach.
• The esophagus has three layers, the mucosa,
submucosa and the muscularis, with the innermost
layer consisting of stratified squamous epithelium
ANATOMY AND PHYSIOLOGY
 Stomach

• The stomach connects the esophagus and the small

intestine or duodenum. It is a J-shaped dilated portion of
the alimentary tract and one of its functions is a holding
reservoir and mixing chamber. It is also located between
the epigastric, umbilical and 479 left hypochondriac
regions of the abdomen. It is divided into four regions:
the cardia, fundus, body and pyloric part. Distally, the
pyloric sphincter is located between the stomach and the
duodenum.
• The stomach has three muscle layers to allow for gastric
motility to move the contents adequately whereas other
parts of the alimentary tract only have two muscle layers
ANATOMY AND PHYSIOLOGY
 Duodenum

• The duodenum is part of the small intestine. It is

approximately 25 cm long and 3.5 cm in diameter

and is the shortest region.

• It begins at the pyloric sphincter of the stomach

and joins the jejunum. Both the pancreas and the

gallbladder release secretions into the duodenum

Rationale
A gastroscopy is undertaken to investigate symptoms originating from the upper GI tract
such as reflux and dysphagia. The doctor or nurse endoscopist uses direct vision to
diagnose, sample and document changes in the upper GI tract.

Indications Contraindications
 Dysphagia.  Fractured base of skull.
 Odynophagia.  Metastatic
 Achalasia. adenocarcinoma.
 Unresponsive reflux disease.  Some head/neck tumours.
 Gastric and peptic ulcers.  Thrombocytopenia.
 Haematemesis and melaena.  Symptoms that are
functional in origin
 Suspected carcinoma.
 Oesophageal or gastric varices.
 Monitoring Barrett's esophagus
disease.
Assessment and recording tools
• A medical and nursing history and assessment must be undertaken
to identify any care needs or concerns that may be significant, in
particular to the patient's current drug therapy, drug reactions or
allergies, any organ dysfunctions such as cardiac and/or respiratory
disease and previous or current illnesses. It is also important to be
aware of any coagulopathies as samples of tissue or biopsy may
need to be taken during the procedure.
• This can be pre-empted by reviewing blood results prior to the
gastroscopy. A set of observations including temperature, pulse,
blood pressure, respiration rate and oxygen saturations should also
be taken to identify any pre-procedural abnormalities and provide a
baseline. If the patient has diabetes, a blood glucose level should
also be checked.
Pharmacological support
• Prior to the procedure, a local anaesthetic spray may be used
on the back of the throat. In some cases conscious sedation
may be administered. This technique involves the
administration of a benzodiazepine such as midazolam in small
doses.
• Doses must be titrated for elderly patients or those with co-
morbidities such as cardiac or renal failure.
• Oxygen therapy should also be administered for patients at risk
of hypoxia or those requiring sedation. Generally 2 litres per
minute is adequate for most circumstances to maintain oxygen
saturation levels and prevent hypoxemia.
Specific patient preparation
• The patient must fast for at least 4-8 hours prior to the gastroscopy to ensure that
the stomach is relatively empty.
• Clear fluids may be taken up to 2 hours before, but local guidelines must be
followed. This increases the visual field for the endoscopist and also minimizes the
risk of aspiration if the patient vomits.
• If the patient has undergone previous gastric surgery, this fasting time may be
longer, dependent on the type of surgery, to ensure gastric emptying.
• The nurse can also assist by getting the patient to lie on their left side on the
trolley.
• If a sedative is used, it is essential that the patient is monitored with pulse oximetry
and observed for any respiratory depression. Nursing staff can observe and record
oxygen saturations and respiratory rate. ECG monitoring may only be required if a
patient is at risk of cardiac instability during the procedure.
COMPLICATIONS
Respiratory depression
If oversedation occurs, respiratory function. will be affected. It is essential that close
monitoring occurs during and after the procedure. A reversal agent may be required
such as flumazenil for midazolam
Perforation
Although rare, it is possible that perforation of the esophagus, stomach or duodenum
may occur. Further medical and/or surgical intervention will be required to manage this
potential complication
Hemorrhage
Where biopsy samples have been taken, this may increase the risk of post-procedural
bleeding. Further intervention may be required to stop the bleeding. Patients should be
advised to seek medical assistance if there are signs of bleeding following discharge,
which include the presence of fresh blood in the sputum and melaena.
This will be dependent on the specific etiology of the bleed, for example whether it is
from varices when variceal band ligation may be required.