Gastro-duodenoscopy

A diagnostic endoscopic procedure that visualizes the upper part of the gastrointestinal tract up to the duodenum. It is considered a minimally invasive procedure since it does not require an incision into one of the major body cavities and does not require any significant recovery after the procedure.

Indications

Diagnostic

 

Surveillance

 

Procedure

The patient is told not to eat, for at least 6 hours before the procedure. Most patients are given a mild sedation although it is possible to have the procedure carried out using an alalgesic throat spray only. The main risks, although very small, are bleeding and perforation. The risk is increased when a biopsy or other intervention is performed.

The patient lies on his/her side with the head resting comfortably on a pillow. The endoscope is then passed over the tongue and into the oropharynx. This is the most uncomfortable stage for the patient. Quick and gentle manipulation guides the endoscope into the oesophagus. The endoscope is gradually advanced down the oesophagus making note of any pathology. The endoscope is passed through the stomach and through the pylorus to examine the first and second parts of the duodenum. Once this has been completed, the endoscope is withdrawn into the stomach and a more thorough examination is performed in order to examine the fundus and gastroesophageal junction. Any additional procedures are performed at this stage. The air in the stomach is aspirated before removing the endoscope. Still photographs can be made during the procedure and later shown to the patient to help explain any findings.

The endoscope is used to inspect the internal anatomy of the digestive tract. Often inspection alone is sufficient, but biopsy is a very valuable adjunct to endoscopy. Small biopsies can be made with a pincer (biopsy forceps) which is passed through the scope and allows sampling of 1 to 3 mm pieces of tissue under direct vision. The intestinal mucosa heals quickly from such biopsies.

Biopsy allows the pathologist to make histologic examination of the biopsy tissue with light microscopy and/or immunohistochemistry. Biopsied material can also be tested on urease to identify Helicobacter pylori, which if found can be treated simply.

Nicholas Boyle

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Julie Wood
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