11/13/24, 8\:18 PM Guide | Gastroscopy explanation

Gastroscopy explanation

Table of contents

Introduction

This article provides a step-by-step guide to explaining a gastroscopy (endoscopy) in an OSCE, including information you will
be expected to give and how to structure the consultation.
The terms gastroscopy, upper GI endoscopy, and oesophagogastrodudenoscopy (OGD) are often used interchangeably.
This guide will cover what a gastroscopy is, what the procedure involves and the risks of the procedure.

Opening the consultation

Wash your hands and don PPE if appropriate.
Introduce yourself to the patient including your name and role.
Con
Explain the reason for the consultation\:
“ I u n d e r s t a n d t h a t y o u’ r e h e r e t o t a l k a b o u t h a v i n g a g a s t r o s c o p y , i s t h i s c o r r e c t ?”
.
Due to the sensitive nature of the consultation, it's important to establish a good rapport and open line of communication with
the patient early in the consultation\:
“ I f y o u h a v e a n y q u e s t i o n s a t a n y p o i n t , o r i f s o m e t h i n g i s n o t c l e a r , p l e a s e f e e l f r e e t o
i n t e r r u p t a n d a s k m e .
”
Make sure to check the patient’s understanding at regular intervals throughout the consultation and provide opportunities to
ask questions (this is often referred to as ‘chunking and checking’).
Throughout the consultation, be receptive to the patient’s language and try only to use words and terminology they
are comfortable with.

Ideas, concerns & expectations

A key component of history taking involves exploring a patient’s ideas, concerns, and expectations (often referred to as ICE) to
gain insight into the patient’s thoughts about having a gastroscopy, what they are worried about and what they expect from the
consultation. When discussing concerns, do so in a sensitive and honest manner.
It can be challenging to use the ICE structure in a way that sounds natural in your consultation, but we have provided
several examples for each of the three areas below.
Ideas
“ W h a t d o y o u a l r e a d y k n o w a b o u t h a v i n g a ga s t r o s c o p y ?”
Concerns
“ I s t h e r e a n y t h i n g w o r r y i n g y o u a b o u t h a v i n g a ga s t r o s c o p y ?”
Expectations
“ W h a t w e r e y o u h o p i n g w e w o u l d c o v e r t o d a y r e l a t i n g t o h a v i n g a ga s t r o s c o p y ?”
“ I s t h e r e a n y t h i n g y o u e s p e c i a l l y w a n t e d t o f o c u s o n o r d i s c u s s t o d a y ?”
“ W h a t a r e y o u h o p i n g t o g e t o u t o f t h i s c o n s u l t a t i o n ?”

Patient history

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Although the purpose of this station is to explain the procedure, it is a good idea to gather a quick, focused history early in the
consultation.
This should include exploring the patient’s condition and reason for requiring a gastroscopy\:
c o u l d y o u t e l l m e a b i t a b o u t w h y y o u n e e d a ga s t r o s c o p y ?”
Understanding the indication for the procedure will allow you to tailor your explanation.
“ J u s t s o w e a r e o n t h e s a m e p a g e ,

What is a gastroscopy?

Using patient-friendly language, explain that a gastroscopy or oesophagogastrodudenoscopy (OGD), is a procedure
performed by an endoscopist (doctor or specialist nurse) allowing visualisation of the upper gastrointestinal tract. This includes
the oesophagus, stomach and duodenum.
An endoscope (long
stomach then the duodenum. The endoscope has a light source and camera. Samples or biopsies can be taken during the
procedure.
1,2,3,4,5
“ A g a s t r o s c o p y i s a t e s t t o e x a m i n e t h e u p p e r p a r t o f y o u r d i ge s t i v e t r a c t . T h e u p p e r p a r t o f y o u r gu t c o n s i s t s o f y o u r f o o d p i p e
o r o e s o p h a g u s , t h e s t o m a c h a n d t h e
c a m e r a ( e n d o s c o p e ) i s p a s s e d t h r o u g h y o u r m o u t h , d o w n t h e f o o d p i p e t o w a r d s t h e s t o m a c h a n d d u o d e n u m . I m a ge s w i l l b e
r e l a y e d t o a v i d e o m o n i t o r s o t h e o p e r a t o r c a n s e e i n s i d e y o u r g u t , a n d t h e y m a y t a k e s o m e s m a l l s a m p l e s o f c e l l s t o b e
c h e c k e d i n a l a b o r a t o r y c a l l e d a b i o p s y .
”

Why is a gastroscopy performed?

A gastroscopy is a common procedure for diagnosing and monitoring diseases a
and duodenum\:
8
Barrett’s oesophagus
Gastric or oesophageal cancer
Coeliac disease
Hiatus hernia
Oesophageal varicies
Indications for a gastroscopy include\:
2,3,4,6,7
Dysphasia
Persistent dyspepsia (despite treatment)
Persistent nausea or vomiting
Haematemesis or malaena
Unexplained weight loss
Iron de\: to investigate for any upper gastrointestinal causes of bleeding
Upper abdominal mass
“ G a s t r o s c o p y i s a m e d i c a l p r o c e d u r e u s e d t o d i a g n o s e a n d m o n i t o r c e r t a i n c o n d i t i o n s i n t h e u p p e r d i ge s t i v e t r a c t . I t’ s o f t e n
r e c o m m e n d e d w h e n y o u h a v e s y m p t o m s s u c h a s d i
g o a w a y w i t h m e d i c a t i o n , n a u s e a o r v o m i t i n g, o r b r i n gi n g u p b l o o d o r d a r k -c o l o u r e d , s t i c k y , t a r-l i k e s t o o l . I t c a n m o n i t o r
c o n d i t i o n s l i k e g a s t r o e s o p h a g e a l r e
t r a c t .
”

What are the alternatives to gastroscopy?

Gastroscopy is not appropriate for some patients. The main alternative is a Barium swallow or a ‘barium meal’
.
A barium swallow is non-invasive and doesn’t require sedation. The patient drinks barium liquid, which coats the inside of the
oesophagus and stomach. X-rays are taken to produce images of the upper GI tract.
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This can show any motility problems in the oesophagus and identify growths or abnormal areas. However, gastroscopy is
preferred for a detailed mucosa examination and biopsy or lesion removal.
4,9
“ I f a g a s t r o s c o p y i s n o t p o s s i b l e o r r e c o m m e n d e d f o r y o u , a n o t h e r o p t i o n i s a b a r i u m s w a l l o w . T h i s t e s t i s l e s s i n v a s i v e a n d
d o e s n’ t i n v o l v e s e d a t i o n . Y o u w i l l b e a s k e d t o d r i n k a b a r i u m l i q u i d , w h i c h w i l l a p p e a r a s b r i gh t w h i t e o n X -r a y s . T h i s w i l l h e l p u s
t o s e e t h e o u t l i n e o f y o u r o e s o p h a g u s a n d s t o m a c h . U n l i k e ga s t r o s c o p y , a b a r i u m s w a l l o w d o e s n’ t a l l o w a d i r e c t v i e w o f t h e
w a l l s o f y o u r g u t o r a n y s a m p l e s ( b i o p s i e s ) t o b e t a k e n . I t i s s t i l l a u s e f u l t e s t t o h e l p u s s e e a n y m o b i l i t y p r o b l e m s i n y o u r f o o d
p i p e ( o e s o p h a g u s ) o r d e t e c t a n y g r o w t h s o r a b n o r m a l i t i e s .
”

Preparing for a gastroscopy

Patients should receive a letter inviting them to the procedure, informing them of when to stop eating and drinking and which
medications to avoid (e.g. proton pump inhibitors).
Proton pump inhibitors (e.g. omeprazole, lansoprazole) are usually stopped two weeks before the procedure. However, these
medications can be continued in some cases (e.g. severe symptoms or undergoing a follow-up gastroscopy to assess ulcer
healing).
1
Anticoagulants and anti-platelet agents may also need to be stopped before the procedure. However, this depends on several
factors, including the indication for anticoagulation and the bleeding risk of the gastroscopy.
Inform the patient that on the day of the procedure, they should not eat anything for six hours before, but clear
consumed up to two hours before.
10,11
“ Y o u w i l l r e c e i v e a l e t t e r i n t h e p o s t t e l l i n g y o u w h e n y o u r a p p o i n t m e n t i s . m e d i c a t i o n s , e s p e c i a l l y b l o o d t h i n n e r s , o r h a v e a n y a l l e r g i e s .
”
I t i s i m p o r t a n t y o u t e l l t h e c l i n i c i f y o u a r e t a k i n g
“ A c i d-r e d u c i n g m e d i c a t i o n s a r e u s u a l l y s t o p p e d t w o w e e k s b e f o r e t h e t e s t . T h i s i n c r e a s e s t h e d e t e c t i o n o f d i s e a s e . T h i s p e r i o d
w i t h o u t m e d i c a t i o n c a n c a u s e a s l i gh t i n c r e a s e i n s y m p t o m s , b u t t h i s d o e s n’ t c a u s e a n y h a r m .
”
“ O n t h e d a y , s t o p e a t i n g s i x h o u r s b e f o r e y o u r a p p o i n t m e n t . Y o u c a n s t i l l h a v e c l e a r
”

What happens during the procedure?

On arrival

Explain to the patient that when they arrive, a nurse will talk them through the procedure and possible risks, and they will need
to give their written consent. There is no need for the patient to change clothes before the procedure.
The patient can choose between a local anaesthetic throat spray or intravenous sedation\:
5,10,11
Throat spray\: the mouth and back of the throat will be numbed, reducing the gag re
the throat.
Intravenous sedation\: will relax the patient, but they will remain awake during the procedure. The patient will need to have a
cannula placed to administer the medication, and the patient will need to arrange for a responsible adult to take them home
after the procedure and stay with them for 24 hours.
“ B e f o r e y o u c a n h a v e t h e p r o c e d u r e , y o u m u s t gi v e y o u r w r i t t e n c o n s e n t . T h i s w i l l c o n
a g r e e t o p r o c e e d w i t h t h e p r o c e d u r e .
”
“ B e f o r e t h e p r o c e d u r e , y o u w i l l b e o
”
“ A l o c a l a n a e s t h e t i c t h r o a t s p r a y w i l l m a k e y o u r t h r o a t a n d m o u t h f e e l n u m b , p r o c e d u r e e a s i e r a n d m o r e c o m f o r t a b l e .
”
i t w i l l r e d u c e t h e g a g r e
“ I f y o u h a v e a s e d a t i v e , y o u a r e a w a k e , b u t i t r e l a x e s y o u a n d h e l p s y o u t o f e e l c a l m . T h i s w i l l b e g i v e n t h r o u g h a n i n t r a v e n o u s
n e e d l e i n y o u r a r m . Y o u s h o u l d n’ t d r i v e f o r 2 4 h o u r s a f t e r , s o m a k e s u r e y o u h a v e s o m e o n e t o p i c k y o u u p a n d c a n s t a y w i t h y o u
a f t e r t h e p r o c e d u r e u n t i l t h e e
”

Gastroscopy procedure

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A gastroscopy takes 10 to 30 minutes. The patient is taken to a room with the endoscopist and two nurses. They will be asked
to lie on their left side on a couch. The patient may be given a plastic mouth guard to protect their teeth and stop them from
biting the endoscope. A nurse will use suction to clear saliva or secretions from the patient’s mouth.
The operator will gently place the endoscope into the patient’s mouth through the mouthpiece and ask them to swallow the

the endoscope to in
Reassure the patient that they can breathe and swallow during the procedure.
The scope will relay images to a video monitor. The operator may take pictures stored in the patient’s medical records. The
operator may take some biopsies for testing. This is not painful.
1,5,10
“ F o r t h e g a s t r o s c o p y , y o u w i l l b e t a k e n t o a r o o m w i t h t h e e n d o s c o p i s t a n d t w o n u r s e s . O n e n u r s e t o a s s i s t t h e d o c t o r , a n d t h e
o t h e r t o l o o k a f t e r y o u . Y o u w i l l b e a s k e d t o l i e o n y o u r l e f t s i d e o n a c o u c h . Y o u w i l l b e gi v e n a s m a l l p l a s t i c m o u t h p i e c e t o b i t e
o n . T h i s w i l l p r o t e c t y o u r t e e t h . A n u r s e w i l l u s e a s m a l l s u c t i o n t u b e t o r e m o v e s a l i v a p r o d u c e d d u r i n g t h e p r o c e d u r e , l i k e a t t h e
d e n t i s t .
”
“ T h e e n d o s c o p i s t w i l l g e n t l y p l a c e t h e s c o p e i n y o u r m o u t h , a n d y o u w i l l b e a s k e d t o s w a l l o w t h e s c o p e . T h e e n d o s c o p i s t w i l l
a d v a n c e t h e s c o p e d o w n y o u r f o o d p i p e / o e s o p h a gu s d o w n i n t o y o u r s t o m a c h a n d t h e
”
“ A i r w i l l b e p a s s e d i n t o y o u r s t o m a c h ; t h i s m a k e s t h e l i n i n g e a s i e r t o s e e . T h i s a i r i s r e m o v e d a t t h e e n d o f t h e t e s t b u t c a n m a k e
y o u f e e l b l o a t e d a n d u n c o m f o r t a b l e . W h i l e t h i s i s n o t p a i n f u l a n d d o e s n o t a
s o m e d i s c o m f o r t .
”
“ D u r i n g t h e p r o c e d u r e , i m a g e s o f y o u r gu t w i l l b e r e l a y e d t o a v i d e o m o n i t o r . T h e o p e r a t o r m a y t a k e p i c t u r e s a n d t a k e s o m e
s m a l l s a m p l e s o f t i s s u e ( b i o p s i e s ) t o b e s e n t t o t h e l a b o r a t o r y f o r f u r t h e r t e s t i n g; t h i s i s n o t p a i n f u l .
”
“ T h e w h o l e p r o c e d u r e w i l l t a k e 1 0 t o 3 0 m i n u t e s .
”

What happens after the procedure

After the gastroscopy, the patient is moved to a recovery room and closely monitored until they are ready to go home.
If the patient had local anaesthetic throat spray, they can resume their normal activities, including driving, immediately after
the procedure. However, patients should avoid eating or drinking for at least one hour after the test until the sensation in their
throat has returned to normal.
1
Patients who have had intravenous sedation will need a responsible adult to pick them up and stay with them for 24 hours. For
the next 24 hours, patients should avoid driving, operating machinery, drinking alcohol or signing legal documents.
Before the patient is discharged, a doctor or nurse will explain any
eight to ten weeks.
5, 11
“ A f t e r t h e p r o c e d u r e , y o u w i l l b e t a k e n t o a r e c o v e r y r o o m , w h e r e t h e n u r s e s w i l l l o o k a f t e r y o u u n t i l y o u a r e r e a d y t o go h o m e .
”
“ I f y o u h a v e t h e a n a e s t h e t i c t h r o a t s p r a y , y o u c a n d r i v e a n d c o n t i n u e y o u r d a y a s n o r m a l . Y o u s h o u l d n’ t e a t o r d r i n k f o r a t l e a s t
a n h o u r a f t e r t h e p r o c e d u r e u n t i l t h e f e e l i n g i n y o u r t h r o a t r e t u r n s t o n o r m a l .
”
“ I f y o u h a v e s e d a t i o n , i t’ s i m p o r t a n t t o a r r a n g e f o r a r e s p o n s i b l e a d u l t t o p i c k y o u u p a n d s t a y w i t h y o u f o r 2 4 h o u r s a f t e r t h e
p r o c e d u r e u n t i l t h e e
a l c o h o l , o p e r a t i n g h e a v y m a c h i n e r y , o r s i g n i n g l e g a l d o c u m e n t s .
”
“ B e f o r e y o u l e a v e t h e h o s p i t a l , a n u r s e o r d o c t o r w i l l e x p l a i n t h e ga s t r o s c o p y
l a b o r a t o r y a n d e x a m i n e d b y a p a t h o l o g i s t . T h e s e r e s u l t s c a n t a k e e i g h t t o t e n w e e k s .
”

What are the side e

Common side e
1,3,4
Gagging and retching\: reassure the patient this is a natural response to the endoscope touching the back of their throat
Sore throat
Bloating or nausea immediately after
Abdominal pain
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Minor bleeding when a biopsy is taken
Possible risks of a gastroscopy include\:
5
Damage to teeth or dental work
Aspiration pneumonia
Perforation
Infection
Sedation\: risk of allergic reaction or over-sedation leading to cardiopulmonary depression
“ G a s t r o s c o p y i s a v e r y s a f e p r o c e d u r e , b u t t h e r e a r e p o t e n t i a l r i s k s a n d s i d e e
”
“ D u r i n g t h e p r o c e d u r e , i t i s c o m m o n t o h a v e a g a g gi n g o r r e t c h i n g s e n s a t i o n a s t h e s c o p e t o u c h e s t h e b a c k o f y o u r t h r o a t .
A f t e r w a r d s , y o u m a y e x p e r i e n c e a s o r e t h r o a t , d i s c o m f o r t , b l o a t i n g a n d b e l c h i n g d u e t o t h e a i r p a s s i n g t h r o u gh t h e s c o p e .
”
“ I n s o m e c a s e s , t h e r e m a y b e m i n o r b l e e d i n g f r o m b i o p s i e s t a k e n d u r i n g t h e p r o c e d u r e .
”
“ T h e e n d o s c o p e c a n d a m a g e y o u r t e e t h . T o r e d u c e t h i s r i s k , y o u r t e e t h a r e p r o t e c t e d w i t h t h e m o u t h g u a r d .
”
“ H a v i n g a g a s t r o s c o p y c a n c a u s e s m a l l f o o d p a r t i c l e s f r o m y o u r g u t t o f a l l i n t o t h e l u n gs c a u s i n g a c h e s t i n f e c t i o n . T h i s i s w h y
y o u r s t o m a c h n e e d s t o b e e m p t y b e f o r e t h e p r o c e d u r e .
”
“ I n r a r e c a s e s , t h e e n d o s c o p e c a n d a m a ge t h e g u t . T h i s m a y c a u s e b l e e d i n g, i n f e c t i o n a n d r a r e l y a t e a r i n t h e s t o m a c h l i n i n g o r
o e s o p h a g u s . T h i s i s c a l l e d a p e r f o r a t i o n a n d u s u a l l y r e q u i r e s a n o p e r a t i o n t o r e p a i r . M a k e s u r e t o s e e k u r g e n t m e d i c a l a d v i c e i f
y o u e x p e r i e n c e v o m i t i n g b l o o d , s e v e r e a b d o m i n a l p a i n , d i
”

Closing the consultation

Close the consultation by summarising what you have discussed. This allows you to emphasise the key points of the
consultation.
Finally, thank the patient for their time and o
Dispose of PPE appropriately and wash your hands.

Reviewer

Dr Ian Beales
Consultant in Gastroenterology
Clinical Reader in Gastroenterology and Therapeutics

References

1. ULH NHS. Oesophagogastrodudenoscopy (OGD). 2022. Available from\: [LINK]
2. Patient info. Adleman R. Gastroscopy Endoscopy. 2023. Available from\: [LINK]
3. NIDDK. Upper GI Endoscopy. 2017. Available from\: [LINK]
4. Guys and St Thomas NHS. Overview Gastroscopy. 2021. Available from\: [LINK]
5. EKHUFT NHS. Gastroscopy. 2022. Available from\: [LINK]
6. BSG. Guidance on the indications for diagnostic upper GI endoscopy,
from\: [LINK]
7. NHS. Gastroscopy. Why it’s done. 2022. Available from\: [LINK]
8. NHS. Tests and next steps. 2023. Available from\: [LINK]
9. Cancer Research UK. Barium swallow for mouth and oropharyngeal cancer. 2021. Available from\: [LINK]
10. Guys and St Thomas NHS. Preparing for Gastroscopy. 2021. Available from\: [LINK]
11. Guys and St Thomas NHS. After a gastroscopy. 2021. Available from\: [LINK]
https\://app.geekymedics.com/osce-guides/counselling/gastroscopy-explanation/ 5/611/13/24, 8\:18 PM Guide | Gastroscopy explanation
Source\: geekymedics.com
https\://app.geekymedics.com/osce-guides/counselling/gastroscopy-explanation/ 6/6